NSG 600 Module V-VI Discussion 2 Wilkes University

Post White Papers as attachments for review by peers. You will choose 2 papers to critique and return via email, as attachments, to the respective students and faculty.  Please coordinate in this discussion section which critiques students are doing. Each student needs to critique 2 papers, and everyone should have at least one paper peer reviewed.

Improving Reproductive Health with Mobile Birth Control Applications

            Contraception is used by millions of patients worldwide to prevent pregnancy and relieve symptoms from endometriosis, polycystic ovarian syndrome, uterine fibroids, dysmenorrhea, and metrorrhagia (Schrager et al., 2020). Unintended pregnancy in the United States can have many negative health and economic consequences for the person who is pregnant, the infant, and other family members (Dorland et al., 2019). Prenatal care in the United States is lacking in quality and difficult to access for a large portion of the population, specifically those who are uninsured or underinsured (Dorland et al., 2019). As a result of poor prenatal care, pregnant patients have a higher risk of serious health complications, including death (Joseph et al., 2021). A study published in 2021 reported an average maternal mortality rate of 17.4 per 100,000 live births, with mortality rates 2.5 times higher in non-Hispanic Black women compared to non-Hispanic White women (Joseph et al., 2021).

            People of reproductive age need to have increased access to birth control to avoid unintended pregnancy and maternal complications. There are various obstacles that patients encounter when attempting to acquire birth control, and 29% of women who have tried to obtain and fill a birth control prescription reported difficulty accessing a medical provider, maintaining insurance coverage, reliable transportation to appointments and the pharmacy, and the ability to take off of work to go to appointments in person (Dorland et al., 2019; Zuniga et al., 2019). Mobile applications for obtaining birth control can be safe and effective alternative methods to eliminate these barriers and decrease maternal morbidity and mortality.

Background

            Lack of access to reliable and safe birth control increases the number of unintended pregnancies, maternal complications, and increased suffering from many conditions such as endometriosis, polycystic ovarian syndrome (PCOS), uterine fibroids, dysmenorrhea, and metrorrhagia (Schrager et al., 2020). Birth control is commonly discussed for the purpose of preventing unintended pregnancy; however, it can also provide relief of debilitating symptoms such as menstrual cramps, heavy bleeding, and migraines, which can interrupt daily activities and decrease quality of life (Schrager et al., 2020). PCOS, for example, can be managed with hormonal contraception to decrease unwanted symptoms like acne and hirsutism and to regulate the menstrual cycle (Schrager et al., 2020).

            Contraception in the form of oral combined or progestin-only pills, transdermal patch, vaginal ring, injection, implant, and intrauterine device require a prescription from a licensed medical provider which limits access in the U.S. (Schrager et al., 2020). When choosing a contraceptive method, both the risks and benefits must be considered for each individual patient (Schrager et al., 2020). The risk of blood clots and breast cancer may increase with certain estrogen-containing methods, while the risk of ovarian and uterine cancer may decrease with other methods including the combined oral contraceptives and the progestin intrauterine device (Schrager et al., 2020).

            When a patient encounters obstacles accessing birth control, there is a greater risk of unintended pregnancies (Dorland et al., 2019). Pregnancy itself can increase the risk of hypertension, diabetes mellitus, heart failure, and other health consequences that can be lifelong (Cederlof et al., 2022). Maternal morbidity and mortality can result from chronic hypertension, preeclampsia, eclampsia, diabetes mellitus, liver disorders, amniotic fluid embolism, blood clot embolism, cardiomyopathy, ectopic pregnancies, postpartum hemorrhage, and mental disorders (Joseph et al., 2021). Access to safe, effective, and reliable contraception can reduce the number of unintended pregnancies and decrease maternal morbidity and mortality rates; however, access is insufficient for many populations such as adolescents, low socioeconomic status, and those who reside in rural areas with a shortage of providers (Dorland et al., 2019).

Solution

            The availability of prescription contraceptive methods can be made available to a greater number of patients if the platform in which they are distributed is more accessible. Websites and mobile applications allow online medical prescribers to deliver contraception without an in-person visit to the clinic or the pharmacy, as they can often be delivered to the home in discreet packaging (Dorland et al., 2019). Companies that participate in mobile prescription services follow state laws regarding prescribing to minors and adhere to current guidelines when determining if contraception containing estrogen is appropriate for each patient (Dorland et al., 2019). Certain companies, such as PlushCare, require a video consultation with each patient while others, like Nurx, can provide the service through mobile messaging (Dorland et al., 2019).

            The company Nurx has the patient fill out a questionnaire to provide information on their age, smoking status, medical history, allergies, blood pressure, and contraception goals (Dorland et al., 2019; Sullivan, 2023). The patient can request a specific birth control pill, patch, or ring, or a provider can suggest birth control options (Sullivan, 2023). Patients then speak with a provider about their choice, ask any questions they have, and the birth control is dispensed through a pharmacy contracted with Nurx or a personal pharmacy depending on the patient’s preference and insurance coverage (Sullivan, 2023). This service can be provided if the patient does not have insurance or does not wish to use insurance, and if the patient choses to have their prescription shipped to their home it is in a discreet package with a tracking number provided (Sullivan, 2023). The patient continues to have access to medical providers any time they have questions, concerns, or wish to change their birth control (Sullivan, 2023. This service has birth control options as low as $15 a month and there is no subscription fee (Sullivan, 2023).

            These services are not without risk, as they are dispensing prescription drugs without a physical exam. Hypertension, migraines with aura, or a history of smoking, blood clots, or stroke are contraindications for combined hormonal contraception and the patient needs to be aware of their medical history and be honest with the prescriber to avoid complications (Zuniga et al., 2019). Patients may not follow up for pap smears and other routine screenings as closely; however, this is an ongoing issue already as patients do not have adequate access to medical providers (Dorland et al., 2019). Regular messaging to check in with the patients and update their medical history before each prescription renewal can improve patient care and lower the risk of these health complications (Zuniga et al., 2019).

Conclusion

            Mobile applications not only increase the access to birth control for patients who have difficulty accessing health insurance and medical providers, but they increase the quality of life for patients who have conditions that affect their daily activities. Premenstrual symptoms, endometriosis, PCOS, and uterine fibroids are a few examples of conditions that can be relieved by prescription birth control (Schrager et al., 2020). Unintended pregnancy can have serious maternal health consequences and with the lack of access to prenatal care, reliable and effective birth control will improve maternal morbidity and mortality rates in the United States. This alternative method for acquiring prescription birth control can improve both personal and population health and should become a nationwide reproductive health initiative. 

References

Cederlof, E. T., Lundgren, M., Lindahl, B., & Christersson, C. (2022). Pregnancy complications

            and risk of cardiovascular disease later in life: A nationwide cohort study. Journal of the    American Heart Association, 11(2), e023079. https://doi.org/10/1161/JAHA.121.023079

Dorland, J. M., Fowler, L. R., & Morain, S. R. (2019). From cervical cap to mobile app:

            Examining the potential reproductive health impacts of new technologies. Health   Promotion Practice, 20(5), 642-647. https://doi.org/10.1177/1524839919863464

Joseph, K. S., Boutin, A., Lisonkova, S., Muraca, G. M., Razaz, N., John, S., Mehrabadi, A.,

            Sabr, Y., Ananth, C. V., & Schisterman, E. (2021). Maternal mortality in the United           States. Obstetrics and Gynecology, 137(5), 763-771.          https://doi.org/10.1097/AOG.0000000000004361

Schrager, S., Larson, M., Carlson, J., Ledford, K., & Ehrenthal, D. B. (2020). Beyond birth control: Noncontraceptive benefits of hormonal methods and their key role in the general       medical care of women. Journal of Women’s Health, 29(7),937-943.             https://doi.org/10.1089/jwh.2019.7731

Sullivan, D. (2023). 2023 Nurx review: Is it right for you? Healthline.             https://www.healthline.com/health/nurx-reviews

Zuniga, C., Grossman, D., Harrell, S., Blanchard, K., & Grindlay, K. (2019). Breaking down           barriers to birth control access: An assessment of online platforms prescribing birth       control in the USA. Journal of Telemedicine and Telecare, 26(6), 322-331.             https://doi.org/10.1177/1357633X18824828