ACCESS: Advancing Contraceptive Equity and Service Uptake through Telemedicine in the US Safety-Net, 2019-2025

PROJECT SUMMARY ACCESS: Advancing Contraceptive Equity and Service Uptake through Telemedicine in the US Safety-Net, 2019-2025 Unintended pregnancy is a key indicator of health inequity in the US. Unintended pregnancy rates are decreasing overall in the US, but disparities are widening, with unintended pregnancy becoming more concentrated among adolescents, women of color, and women living in poverty. Access to contraceptive services for low-income and other marginalized identities is central to reducing inequities in unintended pregnancy. Telemedicine (TM), has the potential to expand access to care, but widespread use of TM for contraceptive care was limited prior to the COVID19 pandemic. The publicly funded family planning “safety net” system of Community Health Centers (CHCs) is a critical provider of family planning services to historically marginalized populations; however, existing evidence about use of TM for contraceptive services in the US safety net system is limited. This proposal directly addresses this gap. We leverage individual-level clinical data - real world health IT - from a common electronic health record across a national network of CHCS and rigorous multilevel analytic methods to document use of TM compared with face-to-face visits for contraceptive services. Aim 1. Assess whether there is a differential uptake of the use of TM for contraceptive services across community health centers (CHCs). We will focus on key populations (e.g., adolescents, uninsured, Latinas, Black women, rural), clinic characteristics (e.g., Title X status), community-level SDH factors (e.g., social and economic conditions, computer and broadband access), and state factors (e.g., Medicaid expansion) to identify differential uptake in the use of TM (versus face-to-face visits) for contraceptive services for low-income populations. Aim 2. Quantify inequities or unintended consequences of TM utilization for individuals and the health system. We will identify disparities in use of long-acting reversible contraception (LARC) methods (which require an in-clinic visit), method switching at one year, and no-show rates and cancellations by visit modality (TM versus in-person). Aim 3. Understand patient experience of care and preferences for contraceptive services via TM versus in-person. We will conduct semi-structured interviews with patients who receive contraceptive care at CHCs to understand their experiences with TM, barriers and facilitators to receiving contraceptive services through TM versus in-person care, and contextual factors that impact their ability to access contraception through TM versus in-person care.