COVID-19

PICCK’s Statement Responding to COVID-19

As front line healthcare workers and public health professionals, we know that COVID-19 presents many challenges as our time and resources are stretched and the way that we do our work must change. 

We are grateful for the skilled and passionate clinicians and staff across Massachusetts who are responding with courage to the needs of their patients and communities in evidence-based and patient-centered ways.

The PICCK team is thinking a lot about what this pandemic means for contraception and pregnancy care, and sexual and reproductive health and rights more broadly. 

PICCK’s objective is to support Massachusetts’ birth hospitals and their affiliated practices to provide safe, quality, and equitable contraceptive care. COVID-19 changes how we will do this work and in many ways heightens the need for our work.

PICCK’s program model is flexible and we are preparing to adapt our programming in the coming months to include remote programming, resources, materials, guidance, and troubleshooting. 

PICCK is developing a number of state-wide resources and activities to support contraceptive care providers during COVID-19. In the next week, PICCK will be establishing a website page devoted to contraception and COVID-19 resources, our response, and how we can support you. On Thursday, April 2nd at 8am we will be hosting a webinar “Contraception in the time of COVID-19.” We hope to roll out a number of other initiatives in the next one to two months.

We have launched a needs assessment of our partners and colleagues to see how we can adapt and retool to support emerging contraception and pregnancy needs during this pandemic.

PICCK has established a process for checking-in with our partnered hospitals to make sure we address any unique needs they are facing in their practice. Some partners will be requesting remote education sessions and technical assistance related to contraception and COVID-19. Other partners will be continuing their PICCK programming as planned (all remote), and some partners will be postponing PICCK activities until the challenges of COVID-19 are behind us and bandwidth for quality improvement initiatives returns.

As a public health program, we welcome the opportunity to support Massachusetts’ clinicians, staff, patients, and communities in a myriad of ways in the coming months. We would love to hear from anyone with thoughts, questions, or requests for programming or materials. You can reach out to us on our website’s “Contact Us” page, and if desired we can set up a call or email.

–        The PICCK Team

larc removal as an essential service

In light of the current COVID-19 pandemic, routine preventive outpatient services have been broadly suspended or switched to telemedicine across the health care system. On March 15, 2020, the Massachusetts Executive Office of Health and Human Services (EOHHS) issued a memorandum to health care providers instructing them that some medical procedures should be deferred during the pandemic. PICCK believes that clinicians should proceed with the insertion of contraceptive devices according to their individual clinical judgment and institutional policies. However, we believe that removal of contraceptive devices should not be delayed. Declining to schedule removals is potentially unethical as it could compel individuals to continue using a medical device against their will. Individuals may desire removal for a variety of reasons, including a desired return to normal fertility.

The March 15 memorandum from EOHHS states in part:

to focus health care personnel resources on responding to this outbreak and conserve the critical shortage of personal protective equipment, all hospitals and ambulatory surgical centers are directed to postpone or cancel any nonessential, elective invasive procedures…[The Massachusetts Department of Public Health] recommends that providers at each hospital or ambulatory surgical center use their clinical judgment on a case by case basis regarding any invasive procedures that must be done to preserve the patient’s life and health. This does not apply to the cancelation or delay of life sustaining care. DPH defines nonessential, elective invasive procedures as procedures that are scheduled in advance because the procedure does not involve a medical emergency; provided, however, that terminating a pregnancy is not considered a nonessential, elective invasive procedure for the purpose of this guidance. However, the ultimate decision is based on clinical judgement by the caring physician.”

PICCK encourages providers to prioritize the prompt removal of contraceptive devices such as intrauterine devices and subdermal implants upon patient request, according to the following principles:

  • Patients considering contraceptive device removal for the purposes of achieving pregnancy should be made aware that the effects of COVID-19 on pregnancy are currently unknown.
  • Patients seeking device removal due to unacceptable side effects or other reasons unrelated to fertility must weigh their desire for removal against the increased risk of presenting for care in a setting where they may be at increased risk of viral infection due to the potential presence of asymptomatic individuals with COVID-19 illness.
  • Patients should be advised to engage in social distancing when transporting themselves to a device removal appointment and as much as possible within medical facilities.
  • Pre-removal counseling on risks and alternatives may be effectively achieved via telemedicine, minimizing time in the clinic.

Recorded Webinar

How PICCK Can Support You and Your Practice During COVID-19

We welcome the opportunity to support Massachusetts’ clinicians, staff, patients, and communities in a myriad of ways in the coming months. We would love to hear from anyone with thoughts, questions, or requests for programming or materials. You can reach out to us on our website’s “Contact Us” page, and if desired we can set up a call or email.

PICCK-Created COVID-19 Resources

Patient-Facing Resources

How to Access Birth Control Without an In-Person Visit

Telemedicine Best Practices and Considerations

PICCK and Upstream – FAQ: MassHealth Policies on Contraceptive Care via Telehealth, 4/13/2020

Telemedicine Best Practices and Considerations

Sample Protocols for Triaging Visits

Adapted from Nationwide Children’s Hospital – Adolescent Contraception COVID-19 Protocol, 3/23/2020

Adapted from Dr. Elizabeth Micks – Protocol for Family Planning Visits During COVID-19 Outbreak, 3/18/2020

Bridge Methods

Bridge Methods of Contraception

Extended Use of LARC

Extended Use of LARC Methods

Postpartum Contraception

Providing Postpartum Contraception During COVID-19

DEPO-subQ PROVERA 104 Self-Injection

PICCK and Upstream – Coverage of DEPO-subQ PROVERA 104 in Massachusetts, 4/27/2020

PICCK and Upstream – Guideline for DEPO-subQ PROVERA 104 Self-Injection

Curated National COVID-19 Resources

Patient-Facing Resources

COVID-19 Health Literacy Project – COVID-19 Fact Sheets

Futures Without Violence – Information on COVID-19 for Survivors, Communities, and DV/SA Programs

RAINN – We’re Here for You

Planned Parenthood League of Massachusetts – Judicial Bypass

FPNTC – COVID-19 Social Media Toolkit, 5/2020

Organizational Statements

The Faculty of Sexual and Reproductive Healthcare – Essential Services in Sexual and Reproductive Healthcare, 3/24/2020

SMFM – Coronavirus (COVID-19), 3/19/2020

RHAP – Staying Connected and Providing Reproductive Health Care, 3/19/2020 

ACOG, ABOG, AAGL, AGOS, ASRM, SASGOG, SFP, and SMFM – Joint Statement on Abortion Access During the COVID-19 Outbreak, 3/18/2020

NAF – National Abortion Federation (NAF) Statement on Abortion Provision During COVID-19, 3/17/2020

ACOG, AAGL, ASRM, AUGS, SFP, SGS, SMFM, and SGO – Joint Statement on Elective Surgeries, 3/16/2020

EOHHS DPH – The Commonwealth of Massachusetts EOHHS DPH Memorandum: Nonessential, Elective Invasive Procedures in Hospitals and Ambulatory Surgical Centers During the COVID-19 Outbreak, 3/15/2020

MHA – COVID-19: Massachusetts Hospitals Stand Ready

Upstream – Ensuring contraceptive access during the COVID-19 pandemic

Clinical Guidance

Upstream – Phone Staff Scripts to Support Contraceptive Access During COVID-19, 4/6/2020

Betsy Lehman Center for Patient Safety, Massachusetts Medical Society, and the Board of Registration in Medicine – COVID-19 Information for Massachusetts: Medical Office Practice, 4/1/2020

SMFM – Society for Maternal-Fetal Medicine COVID-19 Ultrasound Practice Suggestions, 3/23/2020

ASRM – Patient Management and Clinical Recommendations During the Coronavirus (COVID-19) Pandemic, 3/17/2020

ACOG – Novel Coronavirus 2019 (COVID-19), 3/2020

CDC – Interim Considerations for Infection Prevention and Control of Coronavirus Disease 2019 (COVID-19) in Inpatient Obstetric Healthcare Settings, 2/18/2020

ACOG – COVID-19 FAQs for Obstetrician-Gynecologists, Gynecology

ACOG – Topics: COVID-19

FPNTC – Prioritization of In-Person and Virtual Visits During COVID-19: A Decision-Making Guide for Staff, 4/2020

DEPO-subQ PROVERA 104 Self-Injection

NFPRHA – Self-Administration of Injectable Contraception

Sample Protocols for Triaging Visits

ACOG & SMFM – Outpatient Assessment and Management for Pregnant Women with Suspected or Confirmed Novel Coronavirus (COVID-19), 3/2020

Telemedicine Resources and Guidance

Upstream – Telehealth and Contraceptive Care, 4/6/2020

RHAP – Contraception in the Time of COVID-19, 3/24/2020

Rewire News – Reproductive Health Telemedicine is Here During COVID-19 Outbreak – but not for Abortion, 3/18/2020

Commonwealth of Massachusetts, EOHHS, Office of Medicaid – MassHealth All Provider Bulletin 289, 3/13/2020

MassAFP – Expanded Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak, 3/2020

SMFM – SMFM Coding White Paper: Interim Coding Guidance: Coding for Telemedicine and Remote Patient Monitoring Services during the COVID-19 Pandemic

KFF – Telemedicine and Pregnancy Care, 2/26/2020

ACOG – Implementing Telehealth in Practice, 2/2020

KFF – Telemedicine in Sexual and Reproductive Health, 11/22/2019

Upstream – Contraceptive Telemedicine Services

Beyond the Pill – Contraceptive Care During COVID-19: Telehealth Contraception During the Time of COVID-19

Guidelines for Pregnant and Breastfeeding Women

Michigan Medicine: University of Michigan – Coronavirus Guidance for Pregnant and Breastfeeding Patients, 3/18/2020

CDC – Pregnancy & Breastfeeding, 3/17/2020

BMC – COVID-19 Updates from Our Leaders – Guidance for Pregnant Healthcare Workers, 3/17/2020

SMFM – Coronavirus (COVID-19) and Pregnancy: What Maternal-Fetal Medicine Subspecialists Need to Know, 3/17/2020

Harvard Medical School – Pregnant and Worried about the New Coronavirus?, 3/16/2020

SMFM – Interim ICD-10-CM Coding Guidance: Recommended Coding for COVID-19 and pregnancy

Michigan Medicine: University of Michigan – Strategies to Deliver Safe Prenatal Care for Pregnant Patients during the COVID-19 Pandemic

Counseling on Starting Contraception

RHAP – Quick Start Algorithm – patient requests a new birth control method, 5/2019

FPNTC – Contraceptive Counseling Process Guide, 4/2019

AAP – Contraception

Importance of Providing Postpartum Contraception and Counseling

AJOG – Contraceptive counseling and postpartum contraceptive use

Postpartum Contraception

ACOG – Postpartum Birth Control

ACOG – Using Long-Acting Reversible Contraception (LARC) Right After Childbirth

Slynd – Highlights of Prescribing Information

Nexplanon – Highlights of Prescribing Information

Paragard – Highlights of Prescribing Information

Mirena – Highlights of Prescribing Information

Skyla – Highlights of Prescribing Information

Sample Guidelines and Resources for Abortion

NAF – NAF Sample Guideline: Medication Abortion Telephone Follow-Up, 3/2020

Recorded Webinars

PICCK – Contraception in the Time of COVID-19, 4/2/2020

NAF – Preventing transmission of COVID-19 in the abortion care setting, 3/24/2020

AGL – COVID-19 Preparedness Webinar: Learning from Colleagues and Friends on the Front Lines, 3/20/2020

GOLD Learning – Caring For Our Community During COVID-19: How Perinatal/Lactation Workers Can Protect Themselves, Their Clients, and Their Business, 3/19/2020

SMFM – COVID-19 in Pregnancy: Preparing your Obstetrical Units, 3/19/2020

Research

UCSF has compiled the available research on COVID-19 into one location: COVID Papers

News

The Columbia Mailman School of Public Health Heilbrunn Department of Population and Family Health has created a COVID-19 Gender and Sexual Reproductive Health Digest: Sign up for the digest here