CP26 - Maintaining Access to Family Planning Services During a Pandemic: Drive through DMPA

Poster Type: Innovation

Primary Funding Source: Title X Subcontract

Category: Public Health Crises

Issue or Challenge: When COVID-19 struck the Denver metro area in March 2020, Denver Health (DH) adapted quickly. We limited face to face appointments, except for essential services, and began serving patients using telehealth methods. As an organization, we deemed some services as essential, including OB care, Well Child care and Family Planning services. Many family planning services cannot be offered via telehealth, including LARC procedures, Depo Provera injections (DMPA), and STI testing. In an effort to protect staff and continue to serve patients, we devised methods to continue to provide essential services while minimizing face to face contact.

Description of Innovation: DH implemented multiple changes to the delivery of family planning services to meet patient needs during this uncertain time. One innovation was a “Drive up Depo” workflow implemented at eight community health clinics. As a Title X recipient we house a robust family planning program integrated in Family Medicine, Pediatric, and Women’s Care clinics. Our program includes health educators at each site that provide extensive family planning counseling and services. This team was instrumental in both outreach and implementation efforts.

Key steps included:

• Designing a “drive up” DMPA workflow that mirrored a typical DMPA visit, with telehealth counseling and administration of medication while patients remained in their car
• Workflow approved by nursing and medical leadership
• Piloted workflow at one clinic with a limited schedule of patients over two days, with adaptations based on participant and patient feedback
• Changes to policies to support new workflow including initiation of method for new patients via telehealth, and acceptance of home UPT for patients late for DMPA
• Reviewed new workflow with clinic leadership and health educators and tailored it to work with their specific clinic setting.
• Simultaneous outreach efforts included:
• Communication via EPIC My Chart to all patients (12-45 years) on how to access family planning services during COVID-19
• Social media ads across Denver to inform the community that DH continues to provide Family Planning Services
• Updated messaging on DH Family Planning website
• Telephone outreach to current clients receiving DMPA injections

Impact or Result: We piloted this program at one site shortly after developing the workflow and then implemented it at all of our Family Planning sites. At a time when many clinics were forced to stop offering certain methods and services, this Innovation allowed us to continue to provide this method of contraception in a safer way, decreasing risk of exposure to COVID-19 for both staff and patients. Between March 23, 2020 and April 10, 2020 there were 141 DMPA visits, majority of which used the new workflow.

We received an overwhelming amount of positive feedback about the new workflow. Staff felt safer providing services telephonically and patients highlighted the convenience and safety of the adapted service offering. By mirroring the in person DMPA workflow as much as possible; this innovation did not require any staffing changes. Due to adjustments in health plan coverage during the pandemic we continue to bill normally.

Replicating this Innovation: This is straightforward if you already have systems in place to implement telehealth services and deliver “drive by” services.

Author(s):

Lucy Loomis, MD, MSPH, FAAFP, Director of Family Medicine, Denver Health

Sarah Warsh, RN, WHNP, WHNP, Family Planning Clinical Coordinator, Denver Health and Hospital Authority