JWH eBook - 2
EXPERT PANEL DISCUSSION
vasectomies, pretty much any procedure. And that became a requirement for the whole agency. We had to
step back and look at what we were able to accomplish.
The availability of telehealth has opened a door for
us in a really significant way. However, the second part
of the discussion becomes the issue of access: getting
that appointment in the right time frame for the right
patient.
Dr. Matthews: Access and insurance coverage for
contraceptive devices are two of the main barriers that
we are facing at my academic institution. I am part of an
academic institution in which patients have to come in
with two visits just to obtain their LARC of choice. The
first visit is normally focused on counseling, and then
we determine whether or not the insurance covers the
contraceptive device, and then they return back to the
office to have that device implanted, bringing the patient
visit count to two, which, as we all know in medicine, is
already two visits too many. Access is a problem.
I also work at an underserved clinic, where, thankfully, I was able to obtain a grant and be able to serve
these patients with the contraception of their choice.
But many underserved women within our population
here at our academic institution do not have an option
to get the contraception of their choice if they are not
aware of my clinic that gives a free contraception
option. So those are two of the main barriers that I
think that we are facing currently with LARCs.
Dr. Pickle: I think another challenge is still the wealth
of misinformation that patients, and even some of our
fellow clinicians, have about who are candidates for
LARCs, and the challenges to accessing evidencebased counseling about LARCs that can be such an
important part of that decision tree for pregnancy
prevention or bleeding control. One of the challenges
of the counseling visits, especially if there is a desire to
provide a same day insertion, is that a good portion of
that time is spent dispelling myths about LARC and
redirecting toward the evidence that we have about the
safety of LARCs in all genders and throughout a large
patient population.
Dr. Remen: I believe it is a problem with our misdirected health care system. One thing COVID-19 has
shown us is that our health care system is extremely
nonfunctional and broken, so patients have a hard time
even accessing a provider who can give them the
LARC if they desire it. They often are either uninsured
or underinsured. They have very high deductibles,
very high premiums. For some patients, even a $30 or a
$50 copay for a visit makes an LARC completely inaccessible to them. Many insurers still have many
barriers to covering what is mandated to be covered
under the ACA.
2
I work in family medicine, and another problem
surrounding LARC access is linked to training of
health care practitioners. I did my residency in Alabama, and I received basically no training in LARC at
all during my residency. Now, working as an attending, I have found that many programs within family
medicine do not provide any sort of LARC training at
all. How can you get an LARC if your provider does
not know how to provide one?
Dr. Levine: Excellent points. I am sure many of our
readers will agree, and these issues are relevant to
their own practices. How do you propose that the
utilization of telehealth can potentially address
some of these issues?
Dr. Lambing: Telehealth has really revolutionized
our clinic in terms of the ability to provide an LARC.
Sometimes the counseling requirement can be accomplished in one visit, but sometimes patients need a
little more time to think, meaning that the process of
counseling is split into two separate visits. We can do
that much more easily with telehealth. Then, when it is
time to insert the LARC chosen, it only requires one
visit, and by then we have already addressed the patient's concerns and have discussed the whole procedure. Actually, with telehealth, we can even show the
patients the instruments that we are going to use, so
they are very prepared when they show up.
If it had not been for the coronavirus pandemic, we
would have been years away from telehealth in our
county-run health system, but the accompanying sense
of urgency has revolutionized what we have been able
to accomplish in this short period of time.
Dr. Matthews: I agree with that. I think that telehealth
has tremendously increased access in the sense that
during the pandemic, I also used telehealth a lot, and I
did a lot of my counseling, I did a lot of my vetting
before the patient even came in. I was able to fax over
the information to get all the information for their insurance and make sure that the insurer covered it. A lot
of the groundwork that would have been in that twovisit series was already eliminated.
My only caveat about telehealth is that not all of our
patients have access to a smart device. Not all of our
patients have access to a phone with video capability so
they can visually see what we are going to use to insert
the LARC or visually see us. That realization posed quite
a limitation and a challenge that we had to work through.
For those patients, I did a regular telephone call
instead and called it ''telehealth.'' But we still have
that population, and those are the most vulnerable
populations for an undesired pregnancy. Some of these
patients do not even have access to a telephone to even
get the accurate information that they need.
ยช 2020 by Mary Ann Liebert, Inc.
JWH eBook
Table of Contents for the Digital Edition of JWH eBook
JWH eBook - Cover1
JWH eBook - Cover2
JWH eBook - A
JWH eBook - B
JWH eBook - C
JWH eBook - D
JWH eBook - 1
JWH eBook - 2
JWH eBook - 3
JWH eBook - 4
JWH eBook - 5
JWH eBook - 6
JWH eBook - 7
JWH eBook - 8
JWH eBook - Cover3
JWH eBook - Cover4
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