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]du.
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 and HIPAA
- Telehealth Contraception During the Time of COVID-19
- Telehealth Clinic Workflow Best Practices
- Telehealth and Billing
- Online Pharmacy and Telehealth Visit Resources
- Screening for Family / Intimate Partner Violence with Telehealth
- Financial Resources Available for Physicians and Practices
- Principles of Care
- Patient-Centered Counseling
- Ensuring LARC Removal
- Minimizing Exposure During In-Person Visits
- Minimizing Exposure Risk During Procedures
- Pregnancy During COVID-19
- Abortion as an Essential Service
- No-Test Medication Abortion During COVID-19
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.
As organizations move to telehealth visits, the following guidelines and resources can help you continue to provide high quality counseling and contraceptive methods.
- Provide telehealth patient-centered counseling on range of methods & patient priorities.
- 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.
- Use evidence based extended use for all methods:
- Advise condoms, initiate bridging methods.
- IUD and Implants using extended durations.
- Review risks and benefits of ongoing effectiveness of IUD beyond evidence.
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.
- Contraception in the Time of COVID-19 (RHAP)
- How Well Does Birth Control Work Chart
- Birth Control Choices Fact Sheet (RHAP)
- RHAP Birth Control Methods User Guides
- CDC Medical Eligibility Criteria for Contraceptive Use
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).
- 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.
Guides to facilitate implementing telemedicine capabilities and detailed billing guides.
- AMA quick guide to telemedicine
- AAFP: Using Telehealth to Care for Patients During the COVID-19 Pandemic
- ACOG: Managing Patients Remotely: Billing for Digital and Telehealth Services
- AMA Coding Advice During COVID-19 Emergency
- Website with latest links to federal guidelines, state legislation, and major insurer links.
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.
- 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.
LARC Guidance During COVID-19
- 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 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.
- 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.
- 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).
- 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.
- 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.
- 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.
- Because access to safe abortion care is time-sensitive and vitally important, ACOG and other professional organizations issued an unequivocal statement on March 18, 2020 that they "do not support COVID-19 responses that cancel or delay abortion procedures."
- State Action to Limit Abortion During COVID-19.
- Ensuring Access to an Essential Health Service (NEJM article).
- 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.