Study protocol: ACCESS: (Advancing Contraceptive Equity and Service Uptake through Telemedicine in the US Safety-Net).

Access to desired contraceptive care is a critical component of reproductive autonomy. Telemedicine (TM), or the remote provision of clinical services via technology, in community-based health centers has the potential to expand access to family planning services, potentially enhancing both reproductive autonomy and equity. However, little is known about which patient populations use TM for contraceptive services in the US " safety net" (community-based health centers), if there are inequities in access to TM care, or patient preferences for TM contraceptive care. Also unknown are potential unintended consequences may result from using TM versus face-to-face visits for contraceptive care. This paper describes the protocol for a 5-year, multilevel, mixed-methods study examining the use of TM for contraceptive services across a large network of over 2400 US community-based health centers serving millions of patients. Quantitative analyses will use electronic health record data from the ADVANCE network to identify differences in the use of TM for contraceptive services and quantify inequities or unintended consequences of such use for individuals and the health system. Quantitative outcomes include the use of TM versus face-to-face visits for any contraceptive care, contraceptive method switching, no-show and cancellation rates, and access to long-acting reversible contraception (LARC). Quantitative analyses will include variables at the patient, clinic, and contextual (census tract of patient address and state of clinic location) levels. The qualitative investigation will focus on experiences with TM and factors that may impact access to contraceptive services through TM versus in-person care, providing a comprehensive understanding of both statistical trends and underlying contextual dynamics. Our study will provide real-world evidence about use of TM for contraceptive services in the US "safety net". Our results will help us understand the potential for TM to expand access to contraceptive care and any unintended consequences. Our findings will have broad implications for reducing disparities in contraceptive care access and can inform best practices for TM delivery, as well as policy decisions about payer reimbursements for different TM strategies for contraceptive services.