Telehealth–providing health care services and health education remotely through digital and communication technologies–has been thrusted into the mainstream during the COVID-19 pandemic. Nearly all primary care clinicians in the US (97%) were using some form of telemedicine with patients by April 2020 (2) and telemedicine now accounts for 15 to 20% of health care delivery. (3) On Thursday, September 23, during Teleheath Awareness Week, RHAP hosted a panel exploring the benefits, drawbacks, and equity implication of telemedicine for sexual and reproductive health care. We were pleased to welcome Network members Liz Kaltman, ND, MPH, NCMP, Tina Wheat, MD, MPH, Angeline Ti, MD, MPH, Lin-Fan Wang, MD, and Kaity Stewart, CNM, PMHNP-BC, SANE-A as guest speakers. Throughout the evening, panelists covered a range of topics, including contraceptive care, early pregnancy loss care, abortion care, gender-affirming care, and prenatal care.
Panelists highlighted patient agency and accessibility as key benefits of telemedicine. Patients can have more power in telehealth and can push back against the clinical gatekeeping of health care persistent in the in-patient setting. For example, rejecting the patronizing and harmful practice of requiring an in-person visit for a pap smear before refilling a birth control prescription. Unlike in-person office visits, patients do not have to worry about showing their ID, being misgendered, interacting with police, or securing transportation. Additionally, patients can decide where they are for their telehealth appointment and they can have a number of support people accompany them to their visit if they choose (family members, a therapist, doula, or a friend.) Panelists also highlighted that telemedicine enables clinicians to spend more time with patients – uninterrupted by clinic constraints. Longer appointments have allowed providers to support patients who wanted guidance on IUD self-removal or space to process and grieve an early pregnancy loss.
Telemedicine’s potential to close gaps in health care is expansive. However, there are several access barriers that need to be addressed as this field continues to grow throughout the COVID-19 pandemic and beyond. Limited tech literacy and poor broadband access disproportionately affect elders, houseless people, and folks in rural communities. Additionally, the COVID-19 pandemic has placed many brick and mortar clinics in survival mode with limited resources to invest in telemedicine infrastructure. State laws can also create access obstacles. Currently, nineteen states prohibit telemedicine for abortion care (4) and the complex web of laws governing licensing and prescribing across state lines are difficult for providers to navigate (5). As the geographic area of telehealth expands, guest speakers also emphasize the importance of building out local networks so if telehealth patients far away need an in-person follow up, clinicians are able to refer them to a local clinician who is supportive and practices patient-centered, evidence-based health care.
Our September panel underscored the critical role telemedicine will continue to play in primary care and the fight for health equity. Click here to check out RHAP’s telemedicine resources for clinicians and health care providers. To learn more about telemedicine policy initiatives at the state and national level visit the American Telemedicine Association.