Telehealth for Contraceptive Care During the Initial Months of the COVID-19 Pandemic at Local Health Departments in 2 US States: A Mixed-Methods Approach

Abstract

Objectives: This study examined implementation of telehealth for contraceptive care among health departments (HDs) in 2 Southern US states with centralized/largely centralized governance structures during the early phase of the COVID-19 pandemic. Sustaining access to contraceptive care for underserved communities during public health emergencies is critical. Identifying facilitators and barriers to adaptive service provision helps inform state-level decision making and has implications for public health policy and practice, particularly in states with centralized HD governance. Design: Mixed-methods study including a survey of HD clinic administrators and key informant interviews with clinic- and system-level staff in 2 states conducted in 2020. Setting: Health department clinics in 2 Southern US states. Participants: Clinic administrators (survey) and clinic- and system-level respondents (key informant interviews). Participation in the research was voluntary and de-identified. Main Outcome Measures: (1) Telehealth implementation for contraceptive care assessed by survey and measured by the percentage of clinics reporting telehealth service provision during the pandemic; and (2) facilitators and barriers to telehealth implementation for contraceptive care assessed by key informant interviews. For survey data, bivariate differences between the states in telehealth implementation for contraceptive care were assessed using χ2 and Fisher exact tests. Interview transcripts were coded, with emphasis on interrater reliability and consensus coding, and analyzed for emerging themes. Results: A majority of HD clinics in both states (60% in state 1 and 81% in state 2) reported a decrease in contraceptive care patient volume during March-June 2020 compared with the average volume in 2019. More HD clinics in state 1 than in state 2 implemented telehealth for contraceptive services, including contraceptive counseling, initial and refill hormonal contraception, emergency contraception and sexually transmitted infection care, and reported facilitators of telehealth. Medicaid reimbursement was a predominant facilitator of telehealth, whereas lack of implementation policies and procedures and reduced staffing capacity were predominant barriers. Electronic infrastructure and technology also played a role. Conclusions: Implementation of telehealth for contraceptive services varied between state HD agencies in the early phase of the pandemic. Medicaid reimbursement policy and directives from HD agency leadership are key to telehealth service provision among HDs in centralized states.

Contraceptive care service provision via telehealth early in the COVID‐19 pandemic at rural and urban federally qualified health centers in 2 southeastern states

“…With the steady national growth in the number and capacity of FQHCs, these clinics currently represent over half of the safety‐net clinics subsidized to provide family planning services in the United States 17 . The facilitators and barriers discussed herein are unique to FQHCs compared to health departments, which had primarily policy/structural barriers 44 . Maintaining and continuing to increase access to telehealth in FQHCs, particularly for contraceptive care, will be critical to reducing health care disparities in rural areas 35 .…”

“…17 The facilitators and barriers discussed herein are unique to FQHCs compared to health departments, which had primarily policy/structural barriers. 44 Maintaining and continuing to increase access to telehealth in FQHCs, particularly for contraceptive care, will be critical to reducing health care disparities in rural areas. 35 Supportive reimbursement policies for the provision of telehealth as well as adequate funding for electronic infrastructure and technology in rural areas will facilitate telehealth provision, particularly for contraceptive care, in FQHCs.…”