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M oving contraceptive services online: m odels of care

Dr Thom Van Every MB ChB BSc MBA MRCOG

Conflict of interest statem ent

• I am a shareholder and advisor to Lemonaid Health, a San Francisco-based company which provides online medical care, to patients in the United States.

• Previously founded a company called DrThom, which provided online medical care in the UK, Ireland and Australia.

• Currently employed by ViiV Healthcare, an HIV-focused pharma company.

1. Trends in online care

2. Why this makes good sense for oral contraception3. Important considerations

Outline

• ‘Consumerisation’ of healthcare• Capacity/scarcity of provision

• Technology improvements

Triggers in the system

• From face-to-face to- telephone to telephone

- video/Skype consultations• Provider assesses patient in real-time

First wave of change

• From face-to-face to- telephone to telephone

- video/Skype consultations• Provider assesses patient in real-time

Synchronous care

First wave of change

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• Questionnaire-based assessment - exclusively questionnaires

- ‘smart-’ versus ‘dum-’ live video • Provider assesses results in non-real time

Second wave of change

• Questionnaire-based assessment - exclusively questionnaires

- ‘smart’ versus ‘dum’ live video • Provider assesses results in non-real time

Second wave of change

Asynchronous care

• Increased regulatory uncertainty• What constitutes ‘face-to-face’?

• What constitutes ‘a diagnosis’?• What constitutes ‘care’?

Asynchronous care

• Work in progress!• Asynchronous care

- Batching- Expert algorithms, predicitve analytics,

machine learning- Full delegation of prescribing

Third wave of change

Potential for m achine-learning

A n a ly s e d a ta fro m la rg e v o lu m e s h e a lth re c o rd s – R e a l W o r ld D a ta

G e n e ra te a lg o r ith m s to p re d ic t o p t im a l re c o m m e n d a t io n

A s s e s s in d iv id u a l re q u e s t P re s c r ib e o n p ro v id e r ’s b e h a lf

“H u m a n -m a c h in e s y m b io s is ”

‘R e fe r ’

Crowd-sourced data - reciprocity

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‘Bot’-ify

• Messenger services- some provide API

• Using chat-bots

• A good candidate for this approach• From clinical perspective

- generally healthy cohort, repeat prescriptions- guidelines via MEC

- safety of medicine class1

- can co-package relevant safety messages

- can opt-out

Oral horm onal contraception

1. Over-the-counter access to oral contraceptives. Committee Opinion No. 544. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012:120;1527-31

• Patients can self-assess the risk2,3

• Blood pressure readily obtainable

• May increase access and adherence

Patient perspective

2. Shotorbani S, Miller L, Blough DK, Gardner J. Agreement between women’s and providers’ assessment of hormonal contraceptive risk factors. Contraception 2006;73:501–6.3. Grossman D, Fernandez L, Hopkins K, Amastae J, Garcia SG, Potter JE. Accuracy of self-screening for contraindications to combined oral contraceptive use. Obstet Gynecol 2008;112:572–8

• Do/will patients tell the truth?- Is online better or worse than face-to-face?

• The importance of questionnaire context• Informed consent

• Informed dissent• Regulatory environment

Im portant considerations

• Approaches to spot ‘gamers’• Non-leading questionnaires

• Completely standardised care• Written audit trail and records

Technical safe-guards

• Online advances leading to less direct provider

involvement in oral contraceptive decision-making• Potentially more data-driven and personalised

choices• Tools can be used even if ‘over-the-counter’

• Possible to build in technical safe-guards

In sum m ary

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Thank you!