TABLE 2. Factors Contributing to Reductions in Contraceptive Care Patient Volume and Clinical Staffing Capacity at Health Department Clinics in State 1 and State 2 During the Initial Months of the COVID-19 Pandemic (N = 20 Interviewees)a.
| Factors contributing to reductions in contraceptive care patient volume and representative quotes |
| Reduced staffing capacity |
| “[Nurse practitioners] were the ones making the visits, which means that in clinics where we had the nurse column scheduled, and a nurse practitioner scheduled, those schedules were combined into one schedule. Our numbers dropped off drastically.” (State 1) |
| “We don't have as many providers that are able to provide contraceptive care so the volume of patients specifically for that has decreased.” (State 2) |
| COVID-19 safety protocol |
| “Not only did it decrease because we weren't letting people in the facility but also because we were working with a reduced staff as well.” (State 1) |
| “We can have a limited amount of people in the building.” (State 2) |
| Fear of COVID |
| “In the beginning, I think the fear of COVID itself had all staff very concerned about who was coming into the clinic and who was not.” (State 1) |
| “Our patients had been hesitant to come to the clinic for services if they had concerns regarding COVID-19, the message of staying home.” (State 2) |
| Clinics closed and diverted to other clinics |
| “There were only four sites they could travel to get services. If you lived in very rural areas, you had to travel through a county or two to get services.” (State 2) |
| Patient no-shows |
| “... then they don't keep their appointments because it's too far.” (State 2) |
| Patients delaying care |
| “At the end of this month, we're supposed to be with services back three times a week, so those clinics are starting to fill up and some people don't want to go to a doctor's office to get tested. Some people don't want to go that way to get birth control, because it's actually less costly over here. For those reasons, I've had a lot of people say, ‘Oh, I'll just wait...’” (State 2) |
| Factors contributing to reductions in clinical staffing capacity and representative quotes |
| COVID-19 response impacted job duties |
| “Our staff has also done COVID testing since April 1. That in itself, I had to pull people from the clinics to do COVID testing.” (State 1) |
| “We are having to use our current nursing staff that would normally provide contraceptive services to do contact investigations.” (State 2) |
| Staff quarantined due to COVID exposure or illness |
| “If you have somebody that's exposed to it, they have to be quarantined. If you have an employee that tests positive, they're quarantined.” (State 1) |
| “With any illnesses, and them being out or anybody being evacuated, that impacted [staffing capacity], as well.” (State 2) |
| Care-taking responsibilities |
| “We have had maybe a few that have had to care for children, so they would have to be out. The schools being out was impactful ...” (State 1) |
| “... There were some who had small children whose daycares were closed, who could not work from home who had to use leave to take that time off.” (State 2) |
| Staff working remotely |
| “We had people in our WIC program that were allowed to work from home. We had nurse practitioner seniors, they worked from home.” (State 1) |
| “Staff whose job or duties allowed them to work from home were allowed to work from home ....” (State 2) |
aData are from key-informant interviews and quotes are representative of each topic for each state, where applicable.