Project Title

Telehealth Implementation in Family Planning Clinics in Two Southeastern States During COVID-19

Authors' Affiliations

Jessica Cox, BS, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University Kate Beatty, PhD, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University Liane Ventura, MPH, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University Jordan de Jong, MA, Department of Health Services Management and Policy, College of Public Health, East Tennessee State University

Faculty Sponsor’s Department

Health Services Management & Policy

Type

Oral Competitive

Classification of First Author

Graduate Student-Master’s

Project's Category

Womens Health

Abstract Text

COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Many states issued stay-at-home orders to prevent the spread of the coronavirus. Any non-essential clinical services were canceled or postponed to decrease in-person visits at clinics, which led to clinics having decreased patient volume. Telehealth was used as a way to continue clinical care to patients in an alternate form. Health departments (HD) provide fundamental services to patients based on a sliding fee scale. Federally Qualified Health Centers (FQHC) provide a wide variety of health care services to underserved communities. Policies on the implementation of telehealth varied between the two systems. The concentration of this study is on the characteristics of telehealth service provision before and during the COVID-19 pandemic and future considerations for clinic service provision.

A quantitative analysis was conducted through statewide surveys. The statewide surveys assessed clinic characteristics and contraceptive care service provision among HD family planning clinics and FQHC clinics in two Southeastern states, South Carolina (SC) and Alabama (AL), with similar clinic structures. The survey was conducted from July- November 2020. Survey items included evaluating the impact of COVID-19 on clinical service provision, including services provided prior to (2019) and during (March-June 2020) the pandemic. The response rate was 86.8% (N=112) among HD clinics and 53.8% (N=127) among FQHC clinics. Chi-Squared tests of independence were used to assess differences in service provision among HD and FQHC clinics in SC and AL. Fischer’s Exact test was applied where categorical responses were fewer than five.

Among survey respondents, 64.9% (N=72) of HD clinics and 38.9% (N=49) of FQHC clinics indicated no telehealth services were provided prior to the pandemic (p < .0001). Nearly 35% (N=85) of all clinics reported introducing at least one telehealth service during the pandemic. The most prevalent telehealth service provided by HD clinics during the pandemic was prescribing refills of hormonal contraceptive methods at 58.2% (N=64). FQHC clinics’ most prevalent telehealth service provided during the pandemic was primary health care at 89.8% (N=114). Regarding the future of telehealth, 12.4% (N=12) of HD clinics plan to continue all telehealth services offered during March-June 2020, whereas 52.5% (N=62) of FQHC clinics plan to continue all telehealth services offered during March-June 2020 (p < .001).

These findings highlight the significance of policy and procedures among the HD clinics in states that have a centralized health department structure. The telehealth services adopted by HD clinics and FQHC clinics varied and further research is needed to understand the barriers to telehealth provision in each state. The importance of reimbursement policy for telehealth services plays a vital role in providing contraceptive services, thus it may be critical to expand billing options and maintain reimbursement of telehealth through Medicaid.

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Telehealth Implementation in Family Planning Clinics in Two Southeastern States During COVID-19

COVID-19 was declared a pandemic by the World Health Organization on March 11th, 2020. Many states issued stay-at-home orders to prevent the spread of the coronavirus. Any non-essential clinical services were canceled or postponed to decrease in-person visits at clinics, which led to clinics having decreased patient volume. Telehealth was used as a way to continue clinical care to patients in an alternate form. Health departments (HD) provide fundamental services to patients based on a sliding fee scale. Federally Qualified Health Centers (FQHC) provide a wide variety of health care services to underserved communities. Policies on the implementation of telehealth varied between the two systems. The concentration of this study is on the characteristics of telehealth service provision before and during the COVID-19 pandemic and future considerations for clinic service provision.

A quantitative analysis was conducted through statewide surveys. The statewide surveys assessed clinic characteristics and contraceptive care service provision among HD family planning clinics and FQHC clinics in two Southeastern states, South Carolina (SC) and Alabama (AL), with similar clinic structures. The survey was conducted from July- November 2020. Survey items included evaluating the impact of COVID-19 on clinical service provision, including services provided prior to (2019) and during (March-June 2020) the pandemic. The response rate was 86.8% (N=112) among HD clinics and 53.8% (N=127) among FQHC clinics. Chi-Squared tests of independence were used to assess differences in service provision among HD and FQHC clinics in SC and AL. Fischer’s Exact test was applied where categorical responses were fewer than five.

Among survey respondents, 64.9% (N=72) of HD clinics and 38.9% (N=49) of FQHC clinics indicated no telehealth services were provided prior to the pandemic (p < .0001). Nearly 35% (N=85) of all clinics reported introducing at least one telehealth service during the pandemic. The most prevalent telehealth service provided by HD clinics during the pandemic was prescribing refills of hormonal contraceptive methods at 58.2% (N=64). FQHC clinics’ most prevalent telehealth service provided during the pandemic was primary health care at 89.8% (N=114). Regarding the future of telehealth, 12.4% (N=12) of HD clinics plan to continue all telehealth services offered during March-June 2020, whereas 52.5% (N=62) of FQHC clinics plan to continue all telehealth services offered during March-June 2020 (p < .001).

These findings highlight the significance of policy and procedures among the HD clinics in states that have a centralized health department structure. The telehealth services adopted by HD clinics and FQHC clinics varied and further research is needed to understand the barriers to telehealth provision in each state. The importance of reimbursement policy for telehealth services plays a vital role in providing contraceptive services, thus it may be critical to expand billing options and maintain reimbursement of telehealth through Medicaid.

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