Telemedicine in Sexual and Reproductive Health
KFF analyzed a sample of medical claims obtained from the 2017 IBM Health Analytics MarketScan Commercial Claims and Encounters Database, which contains claims information provided by large employer plans. We only included claims for women ages 15-44 who were enrolled in a plan for more than half a year. We defined outpatient telemedicine utilization to include any clinical interaction between a patient and health care provider (physician or non-physician), delivered via live-video, remote patient monitoring, store and forward technology or telephone. Telehealth claims were captured using procedure modifiers specific to telehealth, including GT and 95 for synchronous telecommunication and GQ for asynchronous telecommunication, and “place of service 2” to indicate delivery by telemedicine. We also analyzed the following procedure codes specific to telehealth: 99441-99444, 98966-98969, G2010, G2012, G9868-G9870, S9110, G0071. Inpatient and emergency department uses of telemedicine were excluded, as were provider-provider interactions.
Per the CDC, OCPs can be safely provided after a thorough medical history and blood pressure measurement. Women with high blood pressure or vascular disease are generally not advised to use combined OCPs (estrogen and progesterone), due to increased risk of heart attack and stroke. Therefore, the CDC recommends a blood pressure measurement be taken before initiation of OCPs, but determines that in instances where a provider cannot take a measurement, the woman may report a prior measurement to her provider. However, studies have shown that women who do not have their blood pressure measured before starting OCPs are at a higher risk of heart attack and ischemic stroke than those who did have their blood pressure taken.
Without an ultrasound, ectopic pregnancy cannot be excluded, however a study >16,000 women seeking medical abortions found the rate of ectopic pregnancy to be exceedingly low (1.3/1,000 pregnancies).