Telemedicine: Is it the Best Solution for Teenagers Looking for Reproductive Health Services?

ABSTRACT

Purpose: During the COVID-19 pandemic, telemedicine emerged as an alternative option for preventive care for adolescents and young adults (AYAs) when in-person care was not safe or feasible. Yet, it is unclear how the quality of virtual services might differ from in-person. In this quality assessment of Between Us Program data, we compared receipt of recommended reproductive health services (RHS) and human papillomavirus (HPV) vaccination during in-person and telemedicine preventive encounters among AYAs in the Hennepin Healthcare System (HHS) throughout the COVID-19 pandemic. Methods: We conducted a retrospective cohort study including adolescents (ages 10-18) and young adults (YAs, ages 19-26) receiving preventive care at HHS, between January 1st and December 31st, 2020. Patients receiving orders for RHS (contraceptive prescriptions, sexually transmitted infection [STI] screenings) and HPV vaccination were followed to determine if they received the recommended procedures. The rate of ordered procedures (patients receiving order/total patients attending a preventive visit) and completed orders (completed order/patients receiving order) were compared between in-person preventive visits and telemedicine visits using χ2 tests. Stratified analyses were conducted comparing adolescents and YAs. P-values < 0.05 were considered statistically significant. Results: A total of 3,677 adolescents and 1,119 YAs received a preventive visit during 2020. Among them, 4,666 (97.8%) were in-person and 106 (2.2%) were virtual. During these visits, 7.7% of AYAs received orders for contraception (n=368);10.9%, STI screening (n=521), and 36.0%, HPV vaccinations (n=1,720). Contraceptive prescriptions and STI screening orders were similar between in-person and telemedicine visits (7.7% vs. 11.3%, p=0.2982 for contraceptive prescriptions;11.2% vs. 11.3%, p=0.9601 for STI screenings), whereas in-person had higher rates of HPV vaccination orders compared to telemedicine (36.6% vs. 10.4%, p<0.0001). The vast majority of STI screening (86.3%) and vaccination orders (95.8%) were completed, though we were unable to assess contraception order completion. There was a similar rate of STI screenings completed and a higher rate of HPV vaccinations completed during in person visits, when compared to telemedicine (86.2% vs. 91.7%, p=0.5847 for STI screenings, and 95.9% vs 81.8%, p=0.0201 for HPV vaccinations). Stratified analyses revealed no differences in rates of orders or orders completed comparing adolescents and YAs. Conclusions: Telemedicine allowed AYAs who were unable to be seen in-person to receive preventive care during the COVID-19 pandemic. During telemedicine visits, there were similar rates of contraceptive prescriptions and STI screening orders, suggesting that telemedicine may be a viable option for AYA preventive care and should be promoted as an alternative for those with barriers to accessing in-person care during and after the pandemic. Notably, HPV vaccination orders were lower when compared to in-person visits, suggesting that virtual care could lead to gaps in vaccination status. Innovative solutions to ensure vaccine access, such as mobile vaccine outreach, could be paired with telemedicine to help navigate these challenges and were implemented at HHS. Future directions include more comprehensive analyses of recommended preventive services during routine adolescent preventive care. Sources of Support The Between Us program is funded by the Family Planning Special Projects of the Minnesota Department of Health.