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Make the connection to online birth control
Thinking of new ways to reach out to patients? Planned Parenthood Columbia Willamette (PPCW) in Portland, OR, has linked services to the Internet. It has an online health center that offers Oregon and Washington women easy, 24/7 access to low-dose, hormonal contraception without requiring an office visit or a trip to the drug store, as well as access to refills, emergency contraception, appointment requests, and health information.
The PPCW Online Health Center and its contraceptive access program, promoted as "Instant Birth Control," increase access to birth control by removing barriers to reproductive health care. By providing a nonthreatening introduction to the importance of annual exams and cancer screening, 25% of online patients who pick up their prescription at a Planned Parenthood clinic schedule an exam there, say program officials. As of March 2008, more than 9,000 contraceptive visits had been provided through the online center.1
Many patients have enjoyed having another option to access birth control, reports Liz Delapoer, PPCW's marketing director. Especially for patients located in rural areas far from a health center or with busy schedules, the convenience of ordering birth control online has been a plus, she notes.
Current low-dose hormonal birth control methods do not require a pelvic exam or cervical and breast cancer screening before administration. Instant Birth Control provides a HOPE visit (hormonal contraception provided with an optional — at another time — physical exam component) conducted via an online or telephone health history, explains Mark Nichols, MD, PPCW medical director. It is followed up with a telephone consultation with appropriate licensed staff, who clarify any history components and provide the appropriate medication teaching and other required components of prescribing based on state rules.
To start the process, a woman goes to PPCW's Online Health Center at its web site, www.ppcw.org, and completes a patient intake and medical history form. She then reads about and selects a method of hormonal contraception; birth control pills, transdermal patches, and vaginal rings are available through the program. A registered nurse or nurse practitioner then reviews the patient's health history and follows up by telephone with additional medical questions.
Once the patient is in contact with clinic nurses, PPCW authorizes two months of medication, with the method of delivery left up to the patient. Patients may choose to have their prescription mailed to them, at no additional cost, or called in to a pharmacy of their choice.
Once the patient receives her birth control, she must have her blood pressure measured and the reading verified by a qualified entity (such as at a clinic or drug store) at any point during her two initial cycles of contraceptive use. The patient then mails or faxes the blood pressure report to PPCW. If the reading is within appropriate limits, up to 11 more cycles of the medication can be prescribed.
Patients must be able to pay for the annual $75 consultation fee and medication up front by credit card. The annual costs for a year of birth control are $360 to $600 for birth control pills, $600 for transdermal patches, and $500 for vaginal rings. The program is not covered by the state Medicaid programs in Washington and Oregon. Patients can be reimbursed by private insurers if their health insurance covers contraceptive services.
To operate the program, Planned Parenthood registered nurses, operating under standing orders of nurse practitioners, review the patients' medical histories and prescribe the medications. Nurse practitioners conduct chart reviews of every patient treated by the registered nurses. During the Instant Birth Control program's first two years of operation, existing nursing and administrative staff were able to fulfill program functions.
PPCW has partnered with four other Planned Parenthood affiliates (Planned Parenthood of Western Washington, Central Washington, Mount Baker, and the Inland Northwest) to offer the contraceptive access service to women in Oregon and Washington. The five affiliates share operating expenses and revenue, thus reducing duplication of health care and support services and, when appropriate, taking advantage of economies of scale, say PPCW officials.
PPCW's Online Health Center is a work in progress. Staff members constantly are looking for ways to improve the patient experience online and make the service more accessible or applicable to patients, says Delapoer.
The Online Health Center is a great service for certain patients, but isn't the best option for everyone, she notes.
At present, patients using the Online Health Center cannot use state or federal funding programs, and they must pay for their services and prescriptions with a credit card, explains Delapoer. For patients who don't have a credit card, who cannot afford their visit, or who want to use one of the funding programs, visiting one of PPCW's other health centers would be a better option for them, she says. "We hope to continue improving and expanding our Online Health Center to serve more patients and provide more services online," says Delapoer.
One Internet venture now in place is the agency's "Take Care Down There" web site, www.takecaredownthere.org, she reports. The web site and its marketing campaign are PPCW's effort to reach out to mature teens and young adults to start conversations about sexual and reproductive health. The web site offers colorful graphics and easy-to-read information on sexual health subjects.
"We wanted to find a way to talk to teens and young adults in a way that they could relate to, that they would find interesting and engaging, and potentially encourage further conversations with friends, teachers, or family about the topics we address," says Delapoer. "We hope to educate this age group about the services offered at Planned Parenthood health centers and encourage them to proactively take care of their reproductive and sexual health."