Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee.
J Public Health Manag Pract. 2022;28(3):299-308. doi: 10.1097/PHH.0000000000001481.
This study examined implementation of telehealth for contraceptive care among health departments (HDs) in 2 Southern US states with centralized/largely centralized governance structures during the early phase of the COVID-19 pandemic. Sustaining access to contraceptive care for underserved communities during public health emergencies is critical. Identifying facilitators and barriers to adaptive service provision helps inform state-level decision making and has implications for public health policy and practice, particularly in states with centralized HD governance.
Mixed-methods study including a survey of HD clinic administrators and key informant interviews with clinic- and system-level staff in 2 states conducted in 2020.
Health department clinics in 2 Southern US states.
Clinic administrators (survey) and clinic- and system-level respondents (key informant interviews). Participation in the research was voluntary and de-identified.
(1) Telehealth implementation for contraceptive care assessed by survey and measured by the percentage of clinics reporting telehealth service provision during the pandemic; and (2) facilitators and barriers to telehealth implementation for contraceptive care assessed by key informant interviews. For survey data, bivariate differences between the states in telehealth implementation for contraceptive care were assessed using χ2 and Fisher exact tests. Interview transcripts were coded, with emphasis on interrater reliability and consensus coding, and analyzed for emerging themes.
A majority of HD clinics in both states (60% in state 1 and 81% in state 2) reported a decrease in contraceptive care patient volume during March-June 2020 compared with the average volume in 2019. More HD clinics in state 1 than in state 2 implemented telehealth for contraceptive services, including contraceptive counseling, initial and refill hormonal contraception, emergency contraception and sexually transmitted infection care, and reported facilitators of telehealth. Medicaid reimbursement was a predominant facilitator of telehealth, whereas lack of implementation policies and procedures and reduced staffing capacity were predominant barriers. Electronic infrastructure and technology also played a role.
Implementation of telehealth for contraceptive services varied between state HD agencies in the early phase of the pandemic. Medicaid reimbursement policy and directives from HD agency leadership are key to telehealth service provision among HDs in centralized states.
本研究考察了在 COVID-19 大流行早期，美国南部两个州具有集中化/大部分集中化治理结构的卫生部门（HD）中，远程医疗在避孕护理方面的实施情况。在公共卫生紧急情况下，维持向服务不足的社区提供避孕护理至关重要。确定适应性服务提供的促进因素和障碍有助于为州一级的决策提供信息，并对公共卫生政策和实践具有影响，特别是在 HD 治理集中的州。
包括对两个州的 HD 诊所管理人员进行调查，并对 2020 年进行的诊所和系统级工作人员进行关键知情人访谈的混合方法研究。
美国南部两个州的卫生部门诊所。
诊所管理人员（调查）和诊所及系统级受访者（关键知情人访谈）。参与研究是自愿和匿名的。
（1）通过调查评估避孕护理的远程医疗实施情况，并用报告大流行期间提供远程医疗服务的诊所百分比来衡量；（2）通过关键知情人访谈评估避孕护理的远程医疗实施的促进因素和障碍。对于调查数据，使用卡方检验和 Fisher 精确检验评估两个州在避孕护理的远程医疗实施方面的差异。对访谈记录进行编码，重点是评分者间可靠性和共识编码，并对出现的主题进行分析。
两个州的大多数 HD 诊所（州 1 为 60%，州 2 为 81%）报告称，与 2019 年的平均水平相比，2020 年 3 月至 6 月期间避孕护理患者数量减少。与州 2 相比，州 1 有更多的 HD 诊所实施了远程医疗服务，包括避孕咨询、初始和续用激素避孕、紧急避孕和性传播感染护理，并报告了远程医疗的促进因素。医疗补助报销是远程医疗的主要促进因素，而缺乏实施政策和程序以及人员配备能力下降是主要障碍。电子基础设施和技术也发挥了作用。
在大流行的早期阶段，各州 HD 机构的避孕服务远程医疗实施情况存在差异。医疗补助报销政策和 HD 机构领导层的指令是集中化州 HD 机构提供远程医疗服务的关键。
