ONLINE BIRTH CONTROL REQUEST

Effective Date: 
Mon, 01/13/2020
Policy: 

ONLINE BIRTH CONTROL PROGRAM

Rapid, easy access to contraception is critical to preventing unintended pregnancy. This standardized procedure allows patients to be evaluated for clinical appropriateness for self-administered birth control (pill, patch, or ring) via an online questionnaire. Once the questionnaire is submitted, it is reviewed by a clinician within 3 business days and if appropriate, the clinician submits a prescription for birth control to the pharmacy directly. With this program, the patient does not have to be evaluated in person.

Patient eligibility:

1.       Registered UCSC students

2.       The program is 100% covered for students with UC SHIP or Cruz Care.

3.       The program is fee for service for students who do not have UC SHIP or Cruz Care.

Procedure: 

Patient Procedure:

1.       The student logs into the student health portal (My Health e-Messenger) and schedules an “Online Birth Control Request.”

2.       The appointment date and time are placeholders and do not require the student to come to the clinic or speak with the clinician during that specified time.

3.       The student is prompted to complete the online questionnaire regarding their most recent blood pressure, birth control history, medical history, and preferred pharmacy.

 

Clinician Procedure:

1.       The clinician (physician, nurse practitioner, or physician assistant) goes to the “Online Request” schedule. This schedule is found on the most right hand column of “Primary Care” in Department view.

2.       The clinician right clicks on the appointment to “View Appt Questionnaire.” If the patient has not completed the questionnaire, the clinician would send a secure message to the patient to complete the questionnaire.

3.       If the patient has completed the questionnaire, the clinician right clicks on the appointment to change the status to “Check In” and then right clicks again to change the status to “Start Visit.”  If a window pop-up requests the number of labels to be printed, please click “Cancel.”The clinician clicks on OpenChart to access the associated encounter note.

4.       The clinician opens the encounter note associated with the appointment and reviews the patient-submitted questionnaire.

5.       The clinician completes the provider section of the template:

a.       Patient Request: new start, refill or other

b.       Medications: review current medication list

c.       Allergies: review current medication/material allergy list

d.       Problem List: review medical history

e.       Blood pressure: review whether patient has had a blood pressure taken in the clinic the past 12 months or whether the patient has had a recent self-measurement within the past 6 months

f.        Assessment: indicate whether patient meets CDC U.S. Medical Eligibility Criteria for Contraception

g.       Diagnosis: indicate most appropriate diagnosis, e.g. “Contraceptive Management”

h.       Encounter Code: click on the encounter code which reflects the time spent reviewing the patient questionnaire and responding to the request, e.g. “Professional:  ONLINE EVAL/MANAGEMENT SERVICE 5-10 MINUTES (99421)”

i.         Medication Orders: if appropriate, prescribe birth control. If it’s a new start, Tarina Fe 1/20 or Aubra EQ 1/20 would be prescribed.  If appropriate, prescribe 1-year prescription (13 packs if taking placebos or 16 packs if continuous dosing). If patient needs follow-up in 3 months, prescribe 3-month supply.

j.         Contraception Prescription: indicate whether 12 months or 3 months prescribed.

k.       Patient Education: indicate what patient education information will be sent in secure message. Or: click the applicable patient counseling topics that will be submitted in the secure message (see text macros at the end of this document).

l.         STI Screening: review patient’s chart for most recent STI results. Indicate whether patient has had STI screening within the past year or not.

m.     HPV Vaccination: review patient’s immunization record and/or scanned documents for documentation of HPV vaccine. Indicate whether patient has completed or not completed HPV vaccine series.

n.       Cervical Cancer Screening: review patient’s chart for most recent pap. Indicate whether patient is up-to-date or due for pap test.

o.       Handouts: click on appropriate patient education handouts to be posted on the student health portal for patient to review, e.g. Combined Contraceptive Pill, HPV FAQ, Asymptomatic STI screening, PAP FAQ, etc. 

6.       The clinician sends a secure message to the student informing them that their online birth control request has been reviewed and what was prescribed or advised.

7.       The clinician returns to the appointment page and right clicks on the appointment to turn the status to “Check Out” after signing the note.

 

SPECIAL CONSIDERATIONS

1.       Blood pressure – if there hasn’t been a blood pressure taken within the past year or if the blood pressure measurement is borderline or elevated, can ask patient for blood pressure to be obtained in clinic or self-measured. Adjust number of packs prescribed accordingly.

2.       “Yes” responses – if there are any “yes” responses, can send a secure message to the student to clarify or schedule a telephone visit to obtain additional information.

3.       Nuvaring – acceptable to refill

4.       Contraceptive patch – acceptable to refill

 

EXAMPLES OF TEXT MACROS

No Patient Questionnaire Submitted (.onlineNF)

Thanks for signing up for the online birth control pill request!

I see that you haven't completed your questionnaire.

Would you log back into Health e-Messenger (https://healthcenter.ucsc.edu/information/make-appointment.html) and complete the questionnaire?

Once you complete the questionnaire, let me know by replying to this message.

Prescription Dispensed (.onlineOCP)

Thanks so much for submitting the online birth control pill request form!

 

[  ] I have sent a birth control prescription to the on-campus pharmacy with 12 refills. The pharmacy will give you a quarter's supply of pill packs at a time. This prescription will be ready for pick up within 1 school day.

 

[  ] I have sent a birth control prescription to the on-campus pharmacy with 3 refills. The prescription will be ready for pick up within 1 school day. Within the next 3 months, please schedule an in-person appointment at the Student Health Center to receive additional refills. Call (831) 459-2500 to schedule. I recommend calling sooner than later because there can be a one-month wait for appointments.

 

[  ] Based on your responses, we would like you to schedule an in-person appointment at the Student Health Center. Call (831) 459-2500 to schedule.

 

[  ] Because we don't have a recent blood pressure measurement for you, please measure your own blood pressure at the blood pressure station outside of Student Health Outreach and Promotion (SHOP) next door to the pharmacy. Reply to this message with your blood pressure measurement. Or you can stop by the Student Health Center on the first floor and tell the receptionist that you need to get your blood pressure checked for online birth control.

 

This is the birth control prescription I sent to the pharmacy:

 

It is common to have spotting (bleeding) during the first 3 months after starting the birth control pill. After 6 months, your periods may become lighter or with no bleeding. If this worries you, please complete the online birth control request form again. Let us know you have too much spotting and/or too light of periods. We can switch you to a different pill.

 

Please see below for additional important information.

Let me know if you have any questions!

 

*************************************************

 

I posted some handouts on your portal, including:

Combined Oral Contraceptives - The Pill

Self-Directed STI Screening - Asymptomatic

Pap Test - Latest Recommendations

HPV FAQs

Progesterone Only Pill

 

The pill handout provides information about how to start the pill, potential side effects, and important reminders. Look out for severe adverse side effects and warning signs of a blood clot, including "ACHES" (Abdominal pain, Chest pain or shortness of breath, Headaches, Eye or vision problems, and Severe leg/calf pain or swelling). Stop the pill and return to the Student Health Center or go to the Emergency Department if any blood clot signs/symptoms develop.

 

If you are traveling on a long train, plane, or car ride, reduce your risk of a clot by walking around at least hourly.

 

Stop by SHOP for more information about birth control options and use.

 

If you're interested in STI screening, read the instructions in the self-directed STI screening handout.

 

Starting at age 21, we recommend pap tests (cervical cancer screening) once every 3 years. If you're 21 years old or older and haven't had a pap test (cervical cancer screening) within the past 3 years, schedule an appointment at the Student Health Center by calling (831) 459-2500.

 

If you haven't completed your HPV (human papillomavirus) vaccine series, please read the HPV handout for more information. Schedule an appointment at the Student Health Center to receive your HPV vaccine.

 

Skipping placebo – new start (.skip)

If you're interested in skipping your periods, I recommend taking the pill as packaged (with the placebo week, 4th week of the pill) for the first 3 packs, and then you can skip the placebo pills afterwards. This is to allow your body to adjust to the pill first before skipping your periods.