A Study of Telecontraception

Abstract

Purpose: Telecontraception has emerged as an alternative to an in-person visit as a method of obtaining contraception. The purpose of our “secret shopper” study was to describe the experience of patients who use tele-contraception to further understand the accessibility of these services and to investigate whether companies effectively screen for contraindications. Methods: This secret shopper study used seven standardized patients trained to represent a range of relative contraindications to oral contraceptives (OCs) and ability to adhere to daily pills. The standardized patients presented to the nine tele-contraception vendors and completed a total of 63 visits requesting OCs between October 1, 2018 and March 31, 2019. Results: Across the 63 visits, a 12-month oral contraceptive supply ranged in cost from $67-519. The mean duration of initial visits was 7.5 minutes (95% CI 6.5-8.5) and 20 visits (32%) required follow-up with a provider via a phone call, video call, or messaging. Three vendors sent prescriptions to a local pharmacy, four vendors mailed contraception to a patient’s home within 1-2 weeks, and two vendors provided both options. Adherence rate to CDC guidelines across the visits was 93.3% (95% CI 86%-100%). Contraindicated oral contraceptives were prescribed in three visits. None of the vendors screened for medication adherence. Only two of the nine vendors discussed the option of using more effective intrauterine or subdermal contraception. Conclusions and Relevance: Telecontraception may reduce barriers to contraception because vendors are convenient and accessible. In addition, adherence to guidelines among telecontraception vendors may be higher than it is among clinics that provide in-person visits. Vendors could increase the quality of their services by improving screening for patient adherence to the regimen of ingesting a pill daily and for rare contraindications to oral contraceptives. Vendors should also make sure that patients are aware of more effective, long-acting, reversible contraceptives.