Evaluating E-Visit Utilization and Efficacy for Oral Contraceptive Pills in a Large, Integrated Health Care System

To describe and compare outcomes, including access to care, timeliness of care, and need for a close follow-up visit, by the following visit modalities: office, telephone, video, and e-visit for women seeking oral contraceptive care.

We conducted a retrospective cohort study of all Kaiser Permanente Northern California patient-initiated encounters in the department of obstetrics and gynecology with a primary diagnosis related to oral contraceptive care in 2023 among women aged 18-50 years, excluding those who were not pregnant or those seeking nonoral contraceptive methods. Outcomes included the time from care initiation to oral contraceptive order, rates of contraceptive orders and pickups, the time from care initiation to medication pickup, and rates of 7-day in-person clinic follow-up by visit modality. Covariates included age, race and ethnicity, neighborhood socioeconomic status, primary language, and comorbidity burden (Elixhauser Comorbidity Index score). Using multivariable regression, we calculated marginal adjusted estimates by modality.

Among 23,122 encounters, the median patient age was 28 years; 20.9% of the women were Asian, 8.9% Black, 32.7% Hispanic, 36.2% non-Hispanic White, and 1.4% none of the above. Telemedicine was more frequently chosen than in-office visits, with 49.3% choosing visits by telephone, 9.9% by video, and 13.7% by e-visit; 27.1% chose office visits. After adjusting for patient characteristics, women who chose e-visits, compared with those who chose an office visit, were more likely to be Black, Hispanic, or Asian (vs White), more likely to primarily speak English, and less likely to have comorbid illnesses. E-visits had the highest adjusted rate of contraceptive orders (92.0%, 95% CI, 91.1-93.0%) and the lowest adjusted rate of 7-day in-person follow-up. All telemedicine modalities had higher contraceptive pickup rates compared with office visits (61.6%). However, rates were slightly higher for telephone (76.7%) and video (76.2%) visits than for e-visits (73.2%). E-visits were associated with the timeliest care: Contraceptive orders were placed 11.3 days faster (95% CI, 10.9-11.8), and pickups occurred 9.5 days sooner (95% CI, 7.7-11.3) compared with office visits.

E-visits for oral contraceptive care may offer a timely and patient-centered method of care delivery with more timely contraceptive orders and pickups and less need for short-term follow-up, compared with other visit modalities. Asynchronous telemedicine presents as an emerging opportunity to increase access to contraceptive care.