I’m going out on a limb here and guessing that many of you have seen a provider for reproductive purposes.  It’s a rite of passage for many women to go to an office to obtain birth control, and for both men and women to get tested for sexually transmitted infections (STIs).  These appointments can admittedly be uncomfortable and/or embarrassing for many people.  What with taking time off work and driving to an office, sitting in a waiting room and avoiding eye contact (while simultaneously doing some covert people-watching), and waiting to see a provider, it seems like there are better ways to spend your day.

My friends:  I have news for you.  There’s a different way to do this!

The always-forward-thinking Planned Parenthood has developed the first reproductive telemedicine program, and started seeing patients in September.  Telemedicine is a hot area in healthcare right now;  it’s basically Skyping with a provider.  You can log into our site,plannedparenthoodcare.org, enter your address and phone number, and connect with the provider who’s available.  You’ll discuss your basic medical history (allergies, medications, etc.) as well as some admittedly sensitive information about sexual health history that we ask everybody.  We ask all the same questions that we would in an office, and the entire visit generally takes about 20 minutes, depending on somebody’s medical history and number of questions.  We are available weekdays, weekends, evenings, and holidays.

You can obtain hormonal birth control methods, including pills, Nuva rings, or patches.  These are delivered to your door within a week.  You can also do testing for chlamydia and gonorrhea, two unfortunately common STIs.  People pee in a cup, fill the little vial with a glorified turkey-baster, and send it back to our lab.  All of our supplies come in discrete packaging–nobody knows what’s inside unless they open it.  The STI kits have the return shipping supplies included.

It has been exciting to be a part of this program!  Like any new service, it has been rife with twists and turns.  There are times that I’ve had to do some apologizing around unexpected issues.  For the most part, though, our clientele has been very pleased with this service.  People are very creative with timing their visits–they’ve connected while sitting in a car during a lunch break, from their kitchen while preparing a meal, from the back seat of a car while a friend drove them to the airport(!)  I always give people props for utilizing this time well!

As awesome as this program is, no healthcare delivery system is perfect.  A few limitations of this one include:

1)  It’s only available in Minnesota and Washington state.  This is where we receive the most complaints;  people are annoyed that we don’t offer it where they live!  For several reasons, these two states were chosen to initiate this program.  We are implementing it, evaluating it, and determining our course of action from this point.  We plan to offer this throughout the country, but this is a massive undertaking on many levels, and we have to start somewhere.  For those of you who live in the other 48 states:  please be patient.  We’re working on getting to you!

2)  It does not work for people who need an exam.  Hormonal contraception is overall safe, but some women cannot or should not use it.  Long-acting contraceptive methods (LARCs), such as intrauterine contraceptive devices (IUCs or IUDs) and Nexplanon implants, are the preferred initial contraception method for the vast majority of women.  These methods have a very low failure rate, ie:  it’s hard for people to screw them up–big reason providers love them.  The downside of IUDs/Nexplanons is that I cannot insert them on a video visit.  I also cannot evaluate somebody who has symptoms concerning for an STI, and will recommend an in-person visit in those cases.

3)  At this point, we accept credit card payments, though we will start billing insurance soon.  Some people are submitting receipts with their insurance companies to attempt reimbursement.  Many have reported success with this, though I never guarantee success with any insurance company.  Maddeningly, Washington Medicaid will not pay for telemedicine, which excludes a large chunk of people who would benefit greatly from this service.  We remain hopeful that as telemedicine continues to become more utilized, and the care provided is shown to be as good as in-office visits, insurance will begin to pay for it.  As is oftentimes the case, people may need to kick and scream for awhile before insurance companies recognize a common-sense approach.

One other caveat:  getting around old-school practices and/or bad education.  The most common question is how people can get birth control without getting an exam;  so many women associate getting their prescriptions (good) with getting a pelvic exam (bad).  You do not need an exam to obtain contraception!  You have not needed to for over a decade!  This archaic practice, which still continues by some behind-the-times providers, is a barrier to getting reliable birth control.  This is unfortunate, since you WILL get a pelvic exam if you become pregnant.  You also do not need an exam for STI screening if you don’t have any physical concerns;  if more people knew this, I believe they’d be more conscientious about getting tested.  I also wish that more people knew that most of us with a sexually-transmitted infection DO NOT have symptoms, contrary to the fear-mongering “educational” tactics of many schools in this country.  The abundance of bad sex education in schools is enough to make my blood boil, but that’s another topic for another post.

So while it has its limitations, the majority of people are good candidates for telemedicine contraception and STI screening services.  If you’re one of them, please consider connecting for a visit.  I hope to see you soon!

Guest post by Kelly G., a nurse-practitioner at Planned Parenthood of the Great Northwest. Professional interests include contraception options and STI management, so she’s ecstatic to be included in this telemedicine project!  She also has a keen interest in treating adolescents and young adults, because she has a good sense of humor and recognizes that they’re smarter than the rest of us.