Best Practices and Resources for Contraception During COVID-19

We want to offer guidance, best practices, and resources for continuing family planning services via telehealth in the time of COVID-19. Please feel free to share resources you are developing with us and direct any questions to [email protected].

We will update this page as more resources become available. You can view or download a PDF version of the Telehealth Resource list here. You can view or download a PDF version of the LARC Guidance list here.

Telehealth Resources & Best Practices

LARC Guidance During COVID-19

Pregnancy Options Guidance During COVID-19

 

Telehealth Resources & Best Practices


Telehealth and HIPAA

Telehealth reproductive health visits are important to improve social distancing and help reduce COVID-19 exposures. Federal privacy regulations have been relaxed and payment policies expanded by DHHS, Office for Civil Rights (OCR), and Centers for Medicare & Medicaid Services (CMS).

Having staff available via telehealth helps:

  • Empower patients regarding social distancing.
  • Provide person-centered contraceptive counseling, method initiation and continuation, as well as method switching.
  • Avoid unnecessary exposure to illness.
  • Preserve staff availability and PPE to see high priority patients.
  • CMS toolkit.

 


Telehealth Contraception During the Time of COVID-19

As organizations move to telehealth visits, the following guidelines and resources can help you continue to provide high quality counseling and contraceptive methods.

Contraception Counseling:

  • Provide telehealth patient-centered counseling on range of methods & patient priorities.

Contraception Initiation:

  • Avoid delays by sending prescriptions to pharmacy, mailing, or pre-packing for pick up.
  • Assess risk of pregnancy using CDC criteria.
  • Need in-person visit for IUD, implant, sterilization, +/- DMPA (consider SQ home admin).
  • Delay visit if COVID-19 symptoms, PUI, pending test results, or asymptomatic contact.
    • Initiate a bridging method as needed.

Contraception Continuation:

  • Use evidence based extended use for all methods:

Contraceptive Change or Discontinuation:

  • IUD and implant removal is an essential reproductive health service. Assure removal on request will be facilitated. Discuss IUD self-removal if appropriate.

Resources:

 


Telehealth Clinic Workflow Best Practices

Below are some best practices for telehealth workflow. AAFP Virtual Visit Algorithm provides guidance on virtual visits.

Registration / Billing

  • Call patients to verify insurance and obtain any documentation in advance.
  • Allow patients to show ID and insurance card over video chat or electronically.
  • Allow payment online in advance.

Scheduling / Triage

  • Call in advance to inform patients of changes (i.e. hour changes, cancellations, screening protocol, accompanying individuals, telemedicine visits, and COVID-19 precautions).
  • Post signs regarding walk-in appointments and triage.
  • Have masks available for anyone with symptoms.

Counselor / Medical Assistant / Intake

  • Maintain roles allowing staff to complete intakes, screening, medical history in advance.
  • Use online tools to allow patients to complete forms and sign electronically (i.e. Docusign).

Protocols

  • Consent patient verbally if electronic or written can’t be obtained.
  • Print protocols so that staff can easily provide the correct information.
  • Use teleconference feature to bring provider / other staff into visit in real time (i.e billing person for coverage question, rather than patient making another call).

Manager / Staffing / Flow

  • Monitor staffing, sick leave, child care needs, and the ability of staff to come to work.
  • Minimize staff traveling between sites to reduce risk of transmission.
  • Prepare back-up staffing for absences of up to 2 weeks.
  • Allow staff to work from home if possible.
  • Huddle with staff 1-2 times daily to update workflows.
  • Streamline activities (i.e. complete lab orders in advance so patient just leaves specimen).

Nurse / Provider

  • Be available to assist staff in the triage screening process and troubleshoot workflows in real time.
  • Use same documentation for telehealth visits as face to face visits; same requirements.
  • Include documentation for verbal consent.

 


Telehealth and Billing

Guides to facilitate implementing telemedicine capabilities and detailed billing guides.

 


Online Pharmacy and Telehealth Visit Resources

Online telehealth contraceptive services for patients seeking short-acting methods, condoms, or emergency contraception:

  • Bedsider’s “Where To Get It” search engine includes online prescription and delivery services for birth control.
  • Several online services prescribe and/or deliver birth control to patients, including:
    • PillPack: a full-service online pharmacy that delivers medication separated into daily packets (available in most US states).
    • PRJKT RUBY: allows patients to order birth control online without a provider visit (available in most US states).
    • Planned Parenthood Direct: telehealth birth control visits through app ( available in some US states).

Pharmacist-prescribed birth control:

  • Pharmacist-prescribed birth control now in 7 states: CA, CO, HI, NM, OR, TN, WA.
  • See map of participating pharmacies here

 


Screening for Family / Intimate Partner Violence with Telehealth

  • When initiating a telehealth visit, scan your room and introduce any other staff that are in the room and then ask the patient who else may be in the room with them.
  • Include a standard screening question on IPV, and give standard instruction to alert provider if they can’t safely continue conversation (chat feature, safe word, hand gesture, etc).
  • Consider intake forms patients can complete privately.
  • Futures Without Violence COVID-19 resource list.

 


Financial Resources Available for Physicians and Practices

ACOG: Financial Support for Physicians and Practices During the COVID-19 Pandemic.

 


 

LARC Guidance During COVID-19


Principles of Care

  • To maintain contraceptive access, most providers are shifting to telehealth visits.
  • All methods, including IUDs and implants, should be made available during pandemic.
  • IUD and implant access is essential, but challenging, during the COVID-19 response.
  • Telehealth visits can be used to screen and offer patient centered counseling.
  • For contraceptive best practices during COVID-19, see Beyond the Pill Telehealth Resources, ACOG, FPNTC, RHAP.

 


Patient-Centered Counseling

  • Patient-centered counseling is key to ensuring access to method that fits each individual patient’s priorities.
  • The most effective method is one a patient knows they can use.
  • Prioritizing one method over others can undermine patient autonomy, satisfaction, and continuation.
  • Listen to the patient. 

 


Safety

  • LARC methods (IUDs and implants) are safe for most patients.
  • IUDs and implants are safe for patients with estrogen contraindications (i.e migraines).
  • In-person visits are still needed for IUD and implant insertion and most removals.
  • LARC methods may offer more safety and privacy for some patients.
  • WHO reports a global increase in domestic violence with shelter at home orders, increasing the importance of safe and private methods.

 


Ensuring LARC Removal

  • Patients should have access to start and stop any method.
  • Offer extended use for patients wishing to keep their method, using extended evidence-based durations.
  • IUD and implant removals will usually require a provider visit.
  • Provide IUD self-removal instruction as appropriate (1 in 5 who wished to remove IUD were successful).

 


Minimizing Exposure Risk During In-Person Visits

  • Screen patients prior to and at office arrival for fever, cough, shortness of breath.
  • Delay any procedures if patients are symptomatic.
  • Complete registration, billing, counseling, and consents via phone or telehealth.
  • Offer patients a mask, or have them bring their own.
  • Have patients wait in their car, performing the intake prior to entering the facility.
  • Upon entry, direct immediately into an exam room (minimize moving between rooms).
  • Minimize staff and support people in rooms. Staff can call into room as needed.
  • Monitor PPE supply and adjust use according to CDC guidance.

 


Minimizing Exposure Risk During Procedures

  • IUD and implant insertion or removal are low risk, non-aerosol generating procedures.
  • Routine surgical masks for patient interactions may reduce asymptomatic transmission.
  • Prepare all equipment trays and materials ahead of time to reduce time in the room.

 


 

Pregnancy Options Guidance During COVID-19


Pregnancy During COVID-19

  • Current data does not find pregnant women to be at an increased risk (CDC).
  • Current data finds that transmission does not occur in utero, at delivery, or via breastmilk (CDC). 
  • For further infection prevention and control recommendations, see ACOG and CDC.

 


Abortion as an Essential Service

 


No-Test Medication Abortion During COVID-19

  • Many organizations have moved rapidly toward no test medication abortion with telehealth. 
  • The three protocols below vary slightly. Providers can decide best model for their practice setting.