Room for Telecontraception Quality to Improve

Woman's hand holding cell phone in front of computer

Telecontraception allows individuals to receive contraceptive prescriptions from online vendors. In a letter in the New England Journal of Medicine, Tara Jain of Harvard Medical School, professor in the department of general internal medicine at University of California, Davis, Eleanor B. Schwartz, MD, and associate professor of health care policy Ateev Mehrotra, MD, MPH, conducted a secret shopper study of telecontraception vendors.

In the study people in the research group posed as patients that has a range of contraindications to oral contraceptives to all the available telecontraception vendors. The goal was to understand the processes these vendors use and whether the vendors identified and addressed the contraindications.

It took patients an average of 7.5 minutes to complete the online questionnaires. Most vendors provided follow-ups in various forms including video calls, text messages, and phone calls. Three vendors did not require any patient-provider interaction. Prescriptions were sent to local pharmacies or mailed to the patient’s home within seven days. The average cost for an uninsured patient for the visit, follow-ups, and a 12-month prescription was $313.

In the 45 visits in which patients presented medical contraindication to oral contraceptives 93% of vendors adhered to CDC MEC guidelines, which may be higher than adherence during in-person clinical visits. No vendors screened for ability to ingest a pill daily, and only two vendors mentioned long-acting reversible contraceptive methods.

Telecontraception may remove barriers to contraception as access to the vendors is convenient for most patients. The authors suggest that telecontraceptive vendors could increase their quality by screening for patients’ ability to ingest pills daily as well as rare oral contraceptive contraindications. They should also increase the visibility and awareness of long-term reversible contraceptives that can be more effective than oral contraceptives.