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Originally designed to give access to care in areas where there is a shortage of specialty providers, telehealth technology has become a popular health care options. Ninety one percent of those surveyed reported that their telehealth visit was equal or better than that of in-person visits. Ninety five percent said they were absolutely satisfied with their experience.

Telehealth is creating a safe and convenient future for health care. My guest today on Health You is Charity Galgani. This Doctor of Nursing is Planned Parenthood's Director of Clinical Services and works to make sure patients that patients get the best possible service. Galgani is a member of the Midwest Nursey Society, the National Association of Nurse Practitioners in Women's Health and St. Louis Nurses in Advanced Practice.

Ruth: Welcome Charity

Charity: Thanks, Ruth! I appreciate you giving me that introduction. It's nice to be here.

R: Great. I'm looking forward to talking to you! Tell me about your responsibilities as Director of Clinical Services.

C: Essentially, I am responsible for implementation of new clinical services, along with ensuring our established services are going well and sort of getting a fresh look every now and then. I also dabble in quality and regulatory compliance. I'm a big policy writer for my department, that's sort of my "nerdy vice," so I've written over 70 policies in the past year, which again, I am very nerdibly proud of. I'm also a nurse practitioner by trade so I care for patients as well.

R: Well, okay! The subject today is telehealth. Now, I'd imagine that very few people know that it's offered at Planned Parenthood so explain how the system works there.

C: So, we went live with telehealth services in March 2020 actually coinciding with the COVID-19 global pandemic. We knew we had to have an option to meet patients where they were, so there was no question we had to launch telehealth or hesitation to get it up. When I say "services," I'm referring to our two main options. The first is, sort of, a gold standard of telehealth care, which is our direct-to-patient live audio/video platform, while we provide a host of services. The second is our asynchronous app. In this, the patient can download our app called PP Direct. They answer a few questions and they can get UTI treatment sent to the pharmacy, or if they qualify, birth control prescriptions or renewals and emergency contraception, which can be sent to the pharmacy or, if they choose, mailed straight to their door.

R: What's been the response so far from patients?

C: They love it, actually. There's lots of benefits to it. There's an ease of access. Patients don't have to find transportation or child care. And, for some folks, coming to the doctor's office can be really anxiety-provoking so that's one less thing to worry about, right?

R: Right.

C: And patients are receiving the same high-quality health care that they've come to expect all along but all from the safety and comfort from their own home or their couch, or wherever they are, doing their nails or their hair. It's a great way for patients to feel much more comfortable.

R: You know, I've read about how patients when they're in-person with their doctor tend to not ask the right questions because they're so nervous! Because of that comfort level, do you think the communication level improves?

C: Yeah, I definitely think so. Sometimes, I think the patient is a little nervous as first but I sense that the open up really quickly because it's just a much more intimate conversation. Again, being in that comfortable environment, just sitting on your couch, you're more likely to feel relaxed. Nobody is going to be poking or prodding at you. And you definitely can get into a more open dialogue. So, I think it definitely improves that communication stream.

R: So, how many patients are we talking about right now that are using it?

C: Since our March launch, we've served nearly 2,000 patients in the Missouri/Illinois bi-state area. That's about 50 Missouri counties and about 13 Illinois counties where we're seeing these patients do these services from.

R: So, you mentioned this started because of COVID but is this a COVID-only benefit? Or, is this telehealth an added benefit?

C: We launched telehealth specifically to serve patients during the global pandemic but it is absolutely here to stay.

R: All right. I was surprised to learn the scope of services that patients can receive through telehealth. Now, I think one would expect any range of birth control, including emergency contraception, you can get through [telehealth.] But I understand you can also receive treatments for a variety of other conditions: yeast infection, urinary tract infections, bacterial vaginosis. And then there was something else I wasn't familiar with - pre-exposure prophylaxis - which I guess you call PrEP, which is a protocol for patients at high risk of contracting HIV. So, I'm wondering how is all this possible? How can a patient be treated via technology for issues that traditionally have required in-person and invasive attention?

C: Absolutely. I would just go back to thinking about it as this one-on-one convesation with your provider, so we're able to do this and provide so many services because we do, in the end, still perform that high-quality care. We're doing a thorough history and review of systems pertaining to their chief complaints, and just by talking to my patient I can nearly always get a really good sense about what it is they're needing that day, especially when it comes to UTIs or if they're having discharge that needs to be addressed, for example. The same thing applies, we have to be a little more flexible in how we think about it. Like, for pre-exposure prophylaxis, we need to have some labs done before we can write your prescription so that does require finagling with the system and either writing lab [recommendations] for the patient to take or having them come in so they can get their lab done before we send that medication. It's definitely been an exercise in trying new things but, in the end, we do feel like it's serving the patient better overall because, again, we're talking about this visit that's more comfortable for the patient and then, if they have to come into the health center for something it's a very quick in and out, instead of having to come in and sit up to an hour and be in the waiting room for a long time and go through the poking and prodding like we talked about. We are able to do these services because we can still have that one-on-one relationship and talk about the needs of the patient that day and be flexible about how we treat them.

R: So, how does a patient get an appointment and is health insurance required for this?

C: Folks can be seen with or without insurance. Obviously, with insurance we see you and that goes off to your insurance company. For folks who are self-pay, we do offer flat fees based on the service you're having the appointment for and we do upfront payment at the time of check-in with your [medical assistant] and so it's credit card only for the telehealth appointments and we just by the flat fees. We also recently launched STI mail-out testing, so a patient can get basically a collection set sent to their door. They can do their sample and send it right back to the lab, so they never have to leave their house for that. And that's a separate flat fee as well.

R: Okay, so there's no formal billing then? Or is there?

C: That's correct. So, if you do not have insurance then you pay for your service up front.

R: Can a telehealth appointment be conducted on a smartphone?

C: Absolutely. So, essentially what happens is that the patient is going to receive a link prior to their scheduled appointment by text message and email, so both modalities. And then, all they do, when it comes time leading up to their appointment time they will click that link, answer a couple of short questions and then wait for the health care team to show up on the other side. Yes, absolutely a smartphone, some folks use their laptop as well but we do find a lot of people just go ahead and use their smartphone for these visits.

R: Unfortunately, not everybody has access to a smartphone or a laptop or any device like that. Telehealth is supposed to be used in a private setting, but what if the only way a person can get on a computer is, like at the public library? Could you provide service to someone like that who is logged on at a library computer?

C: Yeah, absolutely. We also use the recommendation that the patient do the visit in a private place because there's going to be some sensitive information, whether it's talking about some demographics at check-in or having reproductive health care discussions. We want patients that we prefer them to be in a secure place. But, I will tell you there are patients who have widely varying comfort levels. Some folks are happy walking around the store or walking around at work with their headphones on and answering those questions, no problem. We do our part to recommend a private place, but, we understand that every patient's needs are different and we need to be individualized to meet their needs. So, we will do our very best to accommodate these needs to ensure they are able to get the care that they need and that they deserve.

R: Okay, before we go, anything else you'd like to mention about telehealth?

C: Yeah, I'd just like to encourage folks to check it out. It's kind of a new concept for a lot of folks but it's a really wonderful way to continue getting the care you need during a really difficult and uncertain time. Planned Parenthood is here, we're still here and now we're here on telehealth! Please check us out and we'd be really glad to care for you.

R: Charity Galgani, Director of Clinical Services at Planned Parenthood, thanks so much for your time and your assistance. Thanks for joining us today.

C: Thank you, I appreciate it.


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