Many women already find it difficult to make time for their health, and the shortage of clinics providing Title X funded care has made it even harder for low-income women to access family planning care. An overwhelming majority (99%) of women have used contraception of some form at some point in their life, and it is one of the most common reasons women see a healthcare provider (American College of Obstetricians and Gynecologists [ACOG], 2015). It’s no wonder that alternative ways to access birth control and other family planning services have become popular in the online sector. One company, called Nurx, offers contraception, testing for sexually transmitted infections (STIs), and pre-exposure prophylaxis for HIV all through an online service (Jain, Lu, & Mehrotra, 2019). Another example of a direct-to-consumer telemedicine company is called Pill Club, which offers free or low-cost birth control mailed directly to the patient’s door (Jain, Lu, & Mehrotra, 2019). Pill Club has the added perk of sending other helpful items along with the patient’s birth control, like lubricant samples or a piece of chocolate (Jain, Lu, & Mehrotra, 2019). These innovative companies are providing exactly what patients need during a time when navigating tricky insurance policies and carving out time for appointments is too much hassle.
When it comes to telemedicine, Arizona has been ahead of the curve. The Arizona Telemedicine Council has been meeting quarterly since 1996 (Arizona Telemedicine Program, 2020). Current members of the Council include Senator Heather Carter and Representative Kate Butler, as well as other legislative members, and representatives from agencies like the Arizona Department of Health Services and the University of Arizona (Arizona Telemedicine Program, 2020). Senate Bill 1089 (2019) amended telehealth laws to allow broader scope of telemedicine and ensure coverage of telemedicine services. Overall, the state has been forward-thinking with regards to patients accessing care remotely.
Online applications like Nurx and Pill Club make it easy for women of any income to access the select family planning services they offer (contraception, testing for STIs) (Jain, Lu, & Mehrotra, 2019). But what about broader access to care and health information? Women have healthcare needs beyond contraception and STI testing, after all. A study in Boston evaluated the use of a women’s health mobile application by low-income women (Reyes, Washio, Stringer, & Teitelman, 2018). Recognizing that low-income women statistically have lower access to preventive health services and higher rates of morbidity and mortality, the authors studied a health information app called Everhealthier Women. The app provided an easy method of accessing preventive health information such as screenings and disease-prevention behaviors. Users of the app can create personalized health plans and track which screenings they are due for according to their age and risk factors. The study found that the app was well-received, with women reporting it was easy to use and had helpful information (Reyes, Washio, Stringer, & Teitelman, 2018). Considering that misinformation about contraception is a major hindrance to its use, an app that educates women and promotes self-management of health is very promising (ACOG, 2015).
Representative Daniel Hernandez, Jr. represents Santa Cruz County in Arizona. He is a strong advocate for women in Arizona, especially those who have been impacted by the loss of Title X funding to Planned Parenthood clinics (D. Hernandez, personal communication, February 28, 2020). After Planned Parenthood removed themselves from the Title X program, Representative Hernandez’s constituents have had very few options for accessing family planning care (D. Hernandez, personal communication, February 28, 2020). He reports that women in his county were already limited to only a couple of choices for getting care, and now they are even further restricted (D. Hernandez, personal communication, February 28, 2020). Many women in rural communities find it hard to get transportation to the clinics that could provide them care, so online and mobile applications can be incredibly helpful to these patients.
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As healthcare providers, it is important to realize that health inequities impact patient’s access to care, whether it is a lack of transportation or a lack of available clinics offering affordable care. Telemedicine may feel like it is a new field being explored, but it has been on the radar of Arizona legislators since the 1990’s (Arizona Telemedicine Program, 2020). While there are some aspects of women’s health and family planning care that cannot be dealt with remotely, birth control, health education and promotion, and STI testing are some of the resources being provided by these innovative companies. It is the responsibility of all healthcare providers to be aware of the mobile applications available, and to inform patients having difficulty accessing care about these options.
References:
- American College of Obstetricians and Gynecologists (ACOG). (2015). Committee opinion no. 615: Access to contraception. Obstetrics & Gynecology, 125, 250-255.
- Arizona Telemedicine Program. (2020). Arizona Telemedicine Council. Retrieved from https://telemedicine.arizona.edu/about-us/atc
- Hernandez, D. (2020, February 28). [Phone interview.]
- Jain, T., Lu, R.J., & Mehrotra, A. (2019). Prescriptions on demand: The growth of direct-to-consumer telemedicine companies. Journal of the American Medical Association, 322(10), 925-926. doi: 10.1001/jama.2019.9889
- Reyes, J., Washio, Y., Stringer, M., & Teitelman, A.M. (2018). Usability and acceptability of Everhealthier Women, a mobile application to enhance informed health choices. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 47, 853-861. doi: 10.1016/j.jogn.2018.04.139
- S 1089, 54th Legislature, 2019.
DNP 711 Health Policy 
The United States Healthcare systems is facing challenges such as increasing number of patients with chronic care conditions that require frequent management and follow ups. There are multiple factors that affect care coordination. For example, multiple telephone calls, scheduling, delays, transportation, and support systems. Telehealth medicine and remote monitoring strategies help alleviate some of the challenges the United States healthcare. Telehealth programs allow patients and professionals to remotely exchange data about diagnosis and management of condition. The advancement in technology is aimed to enable early intervention, prevention of worsening symptoms, and reduce secondary care use. The goal is to have better population health outcomes, and promote healthcare savings.
The advancement in private sector technology has created an innovative way to provide healthcare via telemedicine. For the elderly population, this can eliminate travel times, increase frequent monitoring, early detection of worsening chronic conditions, and immediate interventions. In addition, medication delivery advancements have taken place as well. For example, patients are now able to have home medications delivered. The patients can refill medications up to 90 days. For instance, a patient who may have early onset of heart failure symptoms, he or she is able to contact a professional via online, then the patient can be instructed to monitor weight gain, and blood pressures. Then, the patient can be advised to take a dose of Lasix to help with symptom management. This eliminates an emergency room visit, reduces patient worry, and reduces healthcare expenditures.
In conclusion, like you stated in your example, telehealth medicine by passes many potential barriers to actually receiving the healthcare services in a manner that is efficient, effective, and cost saving.
Another key point is that telehealth medicine will help providers reach out to rural areas where healthcare is needed most due to the doctor and nursing shortages.
Reference
Valdivieso, B., García-Sempere, A., Sanfélix-Gimeno, G., Faubel, R., Librero, J., Soriano, E., & Peiró, S. (2018). The effect of telehealth, telephone support or usual care on quality of life, mortality and healthcare utilization in elderly high-risk patients with multiple chronic conditions. A prospective study. Medicina Clínica 151(8), 308-314. Doi: 10.1016/j.medcli.201803.013
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Edie-
Your post was enlightening on private sector innovation in contraception options for women. I have to admit that I had never heard of thepillclub.com. I reviewed the website, services provided, and I am so excited to use this in future practice. The convenience and safety of a pill service is an absolutely refreshing option for patients. Unintended pregnancies from missed appointments or prescription refills can be avoided with this type of innovative service.
Thepillclub.com offers two options for obtaining pills such as transferring of prescription from a primary provider or prescribing birth control after proper health screening has been done. One thing which I was unable to determine from the website was how this online company ensures women are obtaining proper screening for cervical cancer with routine PAP smears and pelvic exams? Do you have any knowledge with telemedicine or private sector how this would or could be handled? Do you know if the company allows for minors to obtain birth control?
I also had not heard of a phone application which can keep track of an individual’s health screenings. I love this concept as well to optimize preventative services and organize due dates. As you stated, this could be a great tool for patients living in areas which do not have multiple providers and can get their needs met through thepillclub.com. I am quite certain there is other apps that could help patients keep track of immunizations, screenings, appointments, and results.
As I was reviewing literature for this blog reply I came across an article which discussed electronic monitoring devices for medicine adherence purposes compared to self-report of taking medication. These devices can determine when a patient opens a package. While I don’t think this is necessary to track for oral birth control the device could be used in populations mandated to take Tuberculosis medication or HIV medication (Smith, Edwards, and Free, 2018).
References
Smith, C., Edwards, P., & Free, C. (2018). Assessing the validity and reliability of self-report data on contraception use in the Mobile technology for improved family planning randomized controlled trial. Reproductive Health. (15) 50.
Thepillclub.com (2020). Retrieved at https://thepillclub.com
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Thank you for an interesting and informative blog post on access to family planning care through telemedicine. I was unaware of that services such as Nurx and Pill Club existed until now. I think that this is a great resource for patients who face barriers in family planning access and clinics who are affected by Title X funding. It is great that Arizona is proactive in telemedicine utilization compared to other states. According to the Kaiser Family Foundation [KFF] (2019), nine percent of OBGYN and 13% of primary care providers use telemedicine with their patients. This is utilization rate is low compared to other specialties such as radiology (40%) and psychiatry (28%) (KFF, 2019). However, in a survey of telemedicine among providers who offer services in reproductive planning, contraceptive management (65%), prenatal care (21%), and STI (17%) services were the most common encounters (KFF, 2019). This survey is reassuring that family planning via telemedicine is beneficial and increases access for these services. I hope that telemedicine will become more widely adopted in clinics as the potential benefits appear to alleviate barriers to health care access and can help reduce the rate of unintended pregnancies in the United States.
Reference
Kaiser Family Foundation. (2019). Telemedicine in sexual and reproductive health. Retrieved from https://www.kff.org/womens-health-policy/issue-brief/telemedicine-in-sexual-and-reproductive-health/
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I enjoyed reading about where the field of women’s health is headed. These innovative companies are a positive pathway for the future of women’s health. I recently learned that Planned Parenthood is offering telemedicine. They have an app called Planned Parenthood Direct which offers birth control and UTI treatment for users. The app also allows patients to schedule appointments to be seen in-person. It currently is offered in 27 states and Washington D.C., including Arizona, and will be available nationwide by the end of 2020. The visit fee is $25 that can be paid for directly in the app, and the clinician has the ability to video with the patient directly in the app. Birth control is available by mail for $25 or through a pharmacy where insurance can be used. This app is helping overcome the loss of Title X and bringing Planned Parenthood services back to individuals who rely on their services. With the increasing restrictions being placed on sexual and reproductive health care, this app helps to break through barriers for individuals to receive timely care and direct health information no matter where they live. The app is free and available on both Apple and Android devices (Planned Parenthood, 2019). I downloaded the app, navigated around and found it easy to use. In a time like this when they are limiting the number of visits due to COVID-19, telemedicine is key. I think this is going to be a learning experience for the way we deliver care from now on. Apps like Planned Parenthood are paving the way for women’s health and how we can be innovative at meeting patients where they are.
Reference
Planned Parenthood. (2019). ‘Planned Parenthood Direct’ app expands to more than half the country. Retrieved from https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-direct-app-expands-to-more-than-half-the-country
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