Telehealth research roundup

What the research shows about telehealth’s safety, acceptability, and ability to improve access to sexual and reproductive health care services.

by Robin Watkins, CNM, WHNP-BC

published 03/03/20

More than 19 million women in need in the US today live in counties where they lack reasonable access to the full range of birth control methods. And people who don’t face geographic barriers to the full range of methods may face other barriers to accessing birth control, such as inability to take time off of work or obtain child care to go to an appointment. Telehealth options have the opportunity to help close some of the gaps in access to birth control and abortion services. But what does the research tell us about telehealth services—how safe they are? How do patients feel about getting sexual and reproductive health through telehealth? Can these services really help overcome barriers to birth control? We’ve rounded up the current research on telehealth services, deliver to your door birth control, and abortion options.

General Health Services

Patient Perceptions of Telehealth Primary Care Video Visits

All patients in this study reported overall satisfaction with video visits, with the majority interested in continuing to use video visits as an alternative to in-person visits. The primary benefits cited were convenience and decreased costs. Some patients felt more comfortable with video visits than office visits and expressed a preference for receiving future serious news via video visit, because they could be in their own supportive environment. Primary concerns with video visits were privacy, including the potential for work colleagues to overhear conversations, and questions about the ability of the clinician to perform an adequate physical examination.

Takeaway: Patients were satisfied with telehealth visits and liked that they were convenient, in a familiar space.

Only 1 in 10 patients use telehealth as lack of awareness hinders adoption

In this survey from J.D. Power, respondents believed the quality of care received in a telehealth visit is lower than that of a doctor’s office visit, feared that the care would be less personal, and that telehealth visits could cost more than in-person visits. Current telehealth users were patients who believed they were in very good health (15.5% vs 0% of people who indicated that they had poor health), people who lived in the Western U.S., and those in suburban and urban areas.

Takeaway: Current telehealth usage is low, with the most common reasons cited as awareness, concerns about quality of care, belief that the services are expensive and less personal.

How Do Low-Income Urban African Americans and Latinos Feel about Telemedicine? A Diffusion of Innovation Analysis

In this study, both urban African Americans and Latinas with low incomes perceived increased and immediate access to multiple medical opinions and reduced wait time as relative advantages of telehealth. However, African Americans expressed more concerns than Latinos about confidentiality, privacy, and the physical absence of the provider. This difference may reflect lower levels of trust in new health care innovations among African Americans resulting from a legacy of past abuses in the U.S. medical system.

Takeaway: Urban African Americans and Latinas with low incomes found telehealth services convenient and appreciated no waiting times, but they expressed concerns about confidentiality, privacy, and safety with using telehealth.

Sexual & Reproductive Health Services

Telemedicine in sexual and reproductive health

A wide range of reproductive health care services are available via telehealth, including hormonal contraception, medication abortions, and sexually transmitted infection (STI) care. These services can replace the need for in-person care in some cases, though most telehealth services today still function as an adjunct to the existing health care system. Despite its potential, telehealth utilization by patients is low and significant barriers exist to its initiation and widespread use. Initiating a telehealth program entails significant investment in technology, and requires overcoming logistical challenges including privacy concerns, licensing of physicians and, malpractice coverage. Insurance coverage of telehealth services varies widely based on the insurance plan and state policies. Insurers typically pay lower rates for telehealth compared to in-person care, and patients may pay out-of-pocket for services normally covered in full in the clinical setting, including contraception and STI screening.

Takeaway: Telehealth technologies may help address unmet reproductive health needs in the U.S., particularly for rural populations and those with transportation and childcare barriers, but there are still barriers to implementation and widespread use, such as cost of setting up telehealth and insurance coverage.

Breaking down barriers to birth control access: An assessment of online platforms prescribing birth control in the USA

Researchers in this study evaluated if the online questionnaires of nine telehealth platforms were sufficiently screening for contraindications to using combination birth control pills based on guidelines in the CDC’s U.S. Medical Eligibility for Contraceptive Use (US MEC). The found that all of the nine telehealth platforms provided evidenced-based contraceptive care, although they noted that additional questions could strengthen online screening questionnaires for all potential contraindicated health conditions.

Takeaway: Telehealth companies are providing evidence-based care when screening patients for birth control prescribing based on the US MEC.

A Study of Telecontraception

This secret shopper study evaluated the safety of the prescribing process for getting combination birth control pills from nine online telehealth companies. It included a total of 63 visits for seven standardized patients. They found that telehealth prescribers adhered to the US MEC, withholding prescriptions when there was a contraindication 93% of the time. Researchers noted that this rate of compliance to the US MEC is actually higher than rates reported for in-person visits.

Takeaway: Further evidence that telehealth companies are providing evidenced-based care when screening patients for birth control prescribing based on the US MEC and potentially following guidelines at higher rates than for prescribing at in-person visits.

Telemedicine for medical abortion: a systematic review

Access to medication abortion via telehealth has the potential to reduce barriers to abortion care for people who have limited geographic access to abortion services. The study builds on the documented safety of telehealth for medication abortion and notes that rates of efficacy and adverse events are approximately equivalent to traditional clinic-based models for providing medication abortion. Patients who accessed medication abortions via telehealth report high rates of satisfaction with these models. The availability of telehealth medication abortion may allow people to terminate pregnancies at earlier gestational ages as they can avoid waiting for appointments or traveling long distances. While state-level legislation regarding telehealth may still create barriers, this new model of care may provide significantly improved access to abortion services while not compromising patient care.

Takeaway: Based on a synthesis of mainly self‐reported data, medical abortion through telehealth is highly acceptable to patients and providers, and success rate and safety outcomes are similar to those reported in literature for in‐person abortion care.

Overall the research show that telehealth is a safe and acceptable way to access birth control and medication abortion services. And while telehealth has great potential to help increase access to sexual and reproductive health care services there is still a lack of awareness of these services and patients have concerns about the confidentiality, privacy, and safety of these services.

Robin Watkins is the Director of Clinical Affairs and Medical Education at the Society of Family Planning. Robin is a midwife and women’s health nurse practitioner focused on expanding provider capacity to offer just, equitable, resonant, and high-quality sexual and reproductive health care. Robin provides clinical care in the Washington, DC area. When she is not talking sex or placing IUDs, you can find her riding her bike on the streets of DC or eating ice cream for dinner.
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