Michael S. Policar, MD, MPH
Changes in LARC Visits During the COVID-19 Public Health Emergency video
Q: Can DepoSubQ be used safely and effectively up to 15 weeks?
A: The patient package insert for Depo-SubQ Provera 104 states that the recommended injection interval is every 12-14 weeks. In the United States, national family planning guidelines, including the CDC Selected Practice Recommendations (SPR), have no specific recommendation about extending the DMPA-SQ interval to 15 weeks. However, a number of studies done in Africa with DMPA-SQ that show that its efficacy is equivalent to DMPA-IM, including use with a 15 week injection interval.
Q: For safe LARC insertion or removal – would you recommend a full gear or the minimum of face shield, surgical mask and gloves?
A: Full PPE gear is not recommended for GYN office procedures, assuming that the patient has a negative COVID-19 screening at intake. The clinician doing the IUD or implant placement or removal should use a surgical (or n95) face mask, eye protection, and gloves (for IUD procedures, non-sterile exam gloves can be used as long as “no-touch” technique is used). Any staff members in the room should wear a surgical mask and gloves as necessary when cleaning countertops and other surfaces after the procedure. The patient should wear a surgical mask, or if not available, a cloth face mask or n95 face mask that is brought to the office.
Q: When telehealth is not feasible, what are your thoughts on the safest way to provide counseling to ensure safety and giving the patient the best counseling for an informed choice?
A: Whether a provider has telehealth capability or not, a telehealth visit may not be possible because the patient doesn’t have access to a computer or smartphone, there is poor quality or no internet access, or the patient is concerned about the cost to their mobile phone data plan for an extended smartphone conversation.
When a telemedicine visit with an audio-visual platform is not available, contraceptive counseling, shared decision making, and consent for a procedure can be done telephonically. During the public health emergency, the federal Title X Program, many commercial health plans, and some state Medicaid programs that cover “telehealth visits” (billed with an Evaluation and Management code with a -95 modifier) permit the use of a telephone-only conversation in lieu of the previously required audio/video interaction. Other payers, including certain state Medicaid programs and state family planning programs, do not permit billing for telephone-only visits, in which case counseling can be performed telephonically but not billed.
Be sure to check the telemedicine policies of each of your payers to determine whether telephonic-only visits can be billed and be aware that these policies may be time-limited and will change when the public health emergency is over.
Q: Are there any new IUDs in the pipeline?
A: Yes. A copper IUD called VeraCept is in phase III clinical trials in the U.S. and a similar-framed levonorgestrel IUD (LevoCept) is nearing Phase III trials. Another copper IU&D called the Mona Lisa NT Cu380 Mini is being compared to the Paragard in a U.S. clinical trial
A: (by David Hubacher) The Mona Lisa NT Mini is T-shaped copper device, shaped like a Mirena, but a bit smaller. Too early to know if/when the Mona Lisa NT Mini and the Veracept will be available in the US. Both products are in the final phase of study.
Q: To what extent are patients expressing a desire to delay pregnancy due to the pandemic?
A: To my knowledge, there are no studies yet on this topic