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Sudhinaraset M, Gipson JD, Nakphong MK, Soun B, Afulani PA, Upadhyay UD, Patil R. Person-centered abortion care scale: Validation for medication abortion in the United States. Contraception 2024; 137:110485. [PMID: 38754758 DOI: 10.1016/j.contraception.2024.110485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/07/2024] [Accepted: 05/11/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE Medication abortions now make up the majority of abortions in the US, with new service delivery models such as telehealth; however, it is unclear how this may impact patient experiences. The objective of the study is to adapt and validate a person-centered abortion care (PCAC) scale for medication abortions that was developed in a global South context (Kenya) for use in the United States. STUDY DESIGN This study includes medication abortion patients from a hospital-based clinic who had one of two modes of service delivery: (1) telemedicine with no physical exam or ultrasound; or (2) in-person with clinic-based exams and ultrasounds. We conducted a sequential approach to scale development including: (1) defining constructs and item generation; (2) expert reviews; (3) cognitive interviews (n = 12); (4) survey development and online survey data collection (N = 182, including 45 telemedicine patients and 137 in-person patients); and (5) psychometric analyses. RESULTS Exploratory factor analyses identified 29-items for the US-PCAC scale with three subscales: (1) Respect and Dignity (10 items), (2) Responsive and Supportive Care (nine items for the full scale, one additional mode-specific item each for in-person and telemedicine), and (3) Communication and Autonomy (10 items for the full scale, one additional item for telemedicine). The US-PCAC had high content, construct, and criterion validity. It also had high reliability, with a standardized alpha for the full 29-item US-PCAC scale of 0.95. The US-PCAC score was associated with overall satisfaction. CONCLUSION This study found high validity and reliability of a newly-developed person-centered abortion care scale for use in the US. As medication abortion provision expands, this scale can be used in quality improvement efforts. IMPLICATIONS This study found high validity and reliability of a newly-developed person-centered care scale for use in the United States for in-person and telemedicine medication abortion.
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Affiliation(s)
- May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States.
| | - Jessica D Gipson
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States; UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States
| | - Michelle K Nakphong
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, CA, United States
| | - Brenda Soun
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, United States
| | - Patience A Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco, CA, United States; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Ushma D Upadhyay
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, United States
| | - Rajita Patil
- UCLA Bixby Center to Advance Sexual and Reproductive Health Equity, University of California, Los Angeles, CA, United States; David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, United States
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Osman S, Churruca K, Ellis LA, Luo D, Braithwaite J. The Unintended Consequences of Telehealth in Australia: Critical Interpretive Synthesis. J Med Internet Res 2024; 26:e57848. [PMID: 39190446 PMCID: PMC11387926 DOI: 10.2196/57848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Despite more than 2 decades of telehealth use in Australia and the rapid uptake during the COVID-19 pandemic, little is known about its unintended consequences beyond its planned and intended outcomes. OBJECTIVE The aim of this review was to synthesize evidence on the unintended consequences of telehealth use in Australia to clarify its impact beyond its planned and intended outcomes. METHODS We conducted a search of 4 electronic databases: Ovid MEDLINE, Ovid Embase, EBSCO CINAHL, and Scopus. A critical interpretive synthesis approach was adopted for its flexibility and interpretive nature. We extracted data about study characteristics and the types and models of telehealth services. The extracted unintended consequences were coded and mapped into the domains and dimensions of the Australian Health Performance Framework. RESULTS Of the 4241 records identified by the search, 94 (2.22%) studies were eligible for data extraction and analysis. Of these 94 studies, 23 (24%) reported largely positive unintended consequences of telehealth associated with health status, while 6 (6%) noted a potential negative impact of telehealth on socioeconomic status. The findings of 4 (4%) of the 94 studies highlighted societal and financial consequences of telehealth beyond the health system. Almost all studies (93/94, 99%) reported unintended consequences under the 5 dimensions of the Australian Health Performance Framework. CONCLUSIONS Our synthesis offers a framework for understanding the unintended consequences of the use of telehealth as an alternative to in-person care in Australia. While we have documented many unintended benefits of telehealth use, our findings also shed light on many challenges of delivering care via telehealth across different domains and dimensions. These findings hold significant practice and policy-making implications for ensuring safe and high-quality care delivery via telehealth.
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Affiliation(s)
- Sagda Osman
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
| | - Dan Luo
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
- The Daffodil Centre, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, Australia
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Hoggart L, Purcell C, Bloomer F, Newton V, Oluseye A. Social connectedness and supported self-management of early medication abortion in the UK: experiences from the COVID-19 pandemic and learning for the future. CULTURE, HEALTH & SEXUALITY 2024; 26:855-870. [PMID: 37830180 DOI: 10.1080/13691058.2023.2258189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 09/08/2023] [Indexed: 10/14/2023]
Abstract
Medication abortion has been established globally as safe and effective. This modality has increased accessibility and the opportunity to centre individual autonomy at the heart of abortion care, by facilitating self-managed abortion. Previous research has shown how self-managed abortion is beneficial in myriad settings ranging from problematic to (relatively) unproblematic contexts of access. In this paper we explore the relationship between self-management and sources of support (including health professionals, family, and friends); as well as considering issues of reproductive control and autonomy. Drawing on qualitative, experience-centred interviews, we utilise the concept of social connectedness to examine how supported self-managed abortion was experienced in the United Kingdom during the COVID-19 pandemic. Overall, self-management was welcomed, with participants speaking positively about managing their own abortion at home. However, a sense of connectedness was crucial in helping participants deal with difficult experiences; and functioned to support individual autonomy in self-care. This paper is the first to examine factors of connection, support, and isolation, as experienced by those undergoing self-managed abortion in the UK in detail. Our research suggests a continued need to advocate for high quality support for self-managed abortion, as well as for choice of abortion method, to support patient-centered care.
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Affiliation(s)
- Lesley Hoggart
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Carrie Purcell
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Fiona Bloomer
- School of Applied Social and Policy Sciences, Ulster University, Belfast, UK
| | - Victoria Newton
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
| | - Ayomide Oluseye
- Faculty of Wellbeing, Education & Language Studies, Open University, Milton Keynes, UK
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Melville C, Corbin B. Sexual and reproductive health rights in Australia: we have much to celebrate but must not be complacent. Med J Aust 2024; 220:112-114. [PMID: 38130239 DOI: 10.5694/mja2.52194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
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Lewandowska M, Carter DJ, Gasparrini A, Lohr PA, Wellings K. Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis. Int J Gynaecol Obstet 2024; 164:286-297. [PMID: 37621171 DOI: 10.1002/ijgo.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. METHODS This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018-2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area-level deprivation. RESULTS The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post-approval. CONCLUSION The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre-approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post-approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions.
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Affiliation(s)
- Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel J Carter
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Gasparrini
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Patricia A Lohr
- Centre for Reproductive Research and Communication, British Pregnancy Advisory Service, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Lewandowska M, Scott R, Meiksin R, Reiter J, Salaria N, Lohr PA, Cameron S, Palmer M, French RS, Wellings K. How can patient experience of abortion care be improved? Evidence from the SACHA study. WOMEN'S HEALTH (LONDON, ENGLAND) 2024; 20:17455057241242675. [PMID: 38794997 PMCID: PMC11128172 DOI: 10.1177/17455057241242675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 03/05/2024] [Accepted: 03/12/2024] [Indexed: 05/27/2024]
Abstract
BACKGROUND Models of abortion care have changed significantly in the last decade, most markedly during the COVID-19 pandemic, when home management of early medical abortion with telemedical support was approved in Britain. OBJECTIVE Our study aimed to examine women's satisfaction with abortion care and their suggestions for improvements. DESIGN Qualitative, in-depth, semi-structured interviews. METHODS A purposive sample of 48 women with recent experience of abortion was recruited between July 2021 and August 2022 from independent sector and National Health Service abortion services in Scotland, Wales and England. Interviews were conducted by phone or via video call. Women were asked about their abortion experience and for suggestions for any improvements that could be made along their patient journey - from help-seeking, the initial consultation, referral, treatment, to aftercare. Data were analyzed using the Framework Method. RESULTS Participants were aged 16-43 years; 39 had had a medical abortion, 8 a surgical abortion, and 1 both. The majority were satisfied with their clinical care. The supportive, kind and non-judgmental attitudes of abortion providers were highly valued, as was the convenience afforded by remotely supported home management of medical abortion. Suggestions for improvement across the patient journey centred around the need for timely care; greater correspondence between expectations and reality; the importance of choice; and the need for greater personal and emotional support. CONCLUSION Recent changes in models of care present both opportunities and challenges for quality of care. The perspectives of patients highlight further opportunities for improving care and support. The principles of timely care, choice, management of expectations, and emotional support should inform further service configuration.
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Affiliation(s)
- Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Scott
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Natasha Salaria
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Patricia A Lohr
- Centre for Reproductive Research & Communication, British Pregnancy Advisory Service, London, UK
| | - Sharon Cameron
- NHS Lothian, Chalmers Centre, Edinburgh, UK
- Queen’s Medical Research Institute, The University of Edinburgh MRC Centre for Reproductive Health, Edinburgh, UK
| | - Melissa Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca S French
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Dunlop H, Sinay AM, Kerestes C. Telemedicine Abortion. Clin Obstet Gynecol 2023; 66:725-738. [PMID: 37910115 DOI: 10.1097/grf.0000000000000818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Telemedicine has become a substantial part of abortion care in recent years. In this review, we discuss the history and regulatory landscape of telemedicine for medication abortion in the United States, different models of care for telemedicine, and the safety and effectiveness of medication abortion via telemedicine, including using history-based screening protocols for medication abortion without ultrasound. We also explore the acceptability of telemedicine for patients and their perspectives on its benefits, as well as the use of telemedicine for other parts of abortion care. Telemedicine has expanded access to abortion for many, although there remain limitations to its implementation.
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Affiliation(s)
| | - Anne-Marie Sinay
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
| | - Courtney Kerestes
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio
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Noonan A, Black KI, Luscombe GM, Tomnay J. What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales. Aust J Prim Health 2023; 29:244-251. [PMID: 36283421 DOI: 10.1071/py22134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/28/2022] [Indexed: 07/20/2023]
Abstract
BACKGROUND Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. METHODS To address this gap, this qualitative study explores through in-depth semi-structured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. RESULTS Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached; (2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. CONCLUSIONS Rural women with unintended pregnancy experienced gaps in service quality and described a lack of woman-centred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy.
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Affiliation(s)
- Anna Noonan
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; and SPHERE Centre for Research Excellence, Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | - Kirsten I Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; and SPHERE Centre for Research Excellence, Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | - Georgina M Luscombe
- School of Rural Health (Dubbo/Orange), The University of Sydney, Orange, NSW 2800, Australia
| | - Jane Tomnay
- Department of Rural Health, The University of Melbourne, Shepparton, Vic. 3630, Australia
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Godfrey EM, Fiastro AE, Ruben MR, Young EV, Bennett IM, Jacob-Files E. Patient Perspectives Regarding Clinician Communication During Telemedicine Compared With In-Clinic Abortion. Obstet Gynecol 2023; 141:1139-1153. [PMID: 37141602 PMCID: PMC10440237 DOI: 10.1097/aog.0000000000005192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/02/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To explore patient perspectives regarding patient-clinician communication during telemedicine medication abortion compared with traditional, facility based, in-clinic visits. METHODS We conducted semi-structured interviews with participants who received either live, face-to-face telemedicine or in-clinic medication abortion from a large, reproductive health care facility in Washington State. Using Miller's conceptual framework for patient-doctor communication in telemedicine settings, we developed questions exploring participants' experiences of the medication abortion consultation, including the clinician's verbal and nonverbal interpersonal approach and communication of relevant medical information, and the setting where care was received. We used inductive-deductive constant comparative analysis to identify major themes. We summarize patient perspectives using patient-clinician communication terms outlined in Dennis' quality abortion care indicator list. RESULTS Thirty participants completed interviews (aged 20-38 years), 20 of whom had medication abortion by telemedicine and 10 who received in-clinic services. Participants who received telemedicine abortion services reported high-quality patient-clinician communication, which came from their freedom to choose their consultation location, and reported feeling more relaxed during clinical encounters. In contrast, most in-clinic participants portrayed their consultations as lengthy, chaotic, and lacking comfort. In all other domains, both telemedicine and in-clinic participants reported similar levels of interpersonal connection to their clinicians. Both groups appreciated medical information about how to take the abortion pills and relied heavily on clinic-based printed materials and independent online resources to answer questions during the at-home termination process. Both telemedicine and in-clinic participant groups were highly satisfied with their care. CONCLUSION Patient-centered communication skills used by clinicians during facility based, in-clinic care translated well to the telemedicine setting. However, we found that patients who received medication abortion through telemedicine favorably ranked their patient-clinician communication overall as compared with those in traditional, in-clinic settings. In this way, telemedicine abortion appears to be a beneficial patient-centered approach to this critical reproductive health service.
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Affiliation(s)
- Emily M Godfrey
- Departments of Family Medicine and Obstetrics and Gynecology, University of Washington School of Medicine, and the University of Washington School of Medicine, Seattle, Washington
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Mazza D, Shankar M, Botfield JR, Moulton JE, Chakraborty SP, Black K, Tomnay J, Bateson D, Church J, Laba TL, Kasza J, Norman WV. Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice. BMJ Open 2023; 13:e065137. [PMID: 36948556 PMCID: PMC10040016 DOI: 10.1136/bmjopen-2022-065137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).
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Affiliation(s)
- Danielle Mazza
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Mridula Shankar
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica R Botfield
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Jessica E Moulton
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Samantha Paubrey Chakraborty
- Faculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Kirsten Black
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane Tomnay
- Department of Rural Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Deborah Bateson
- Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Jody Church
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
| | - Tracey-Lea Laba
- Centre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, UK
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Moulton JE, Mazza D, Tomnay J, Bateson D, Norman WV, Black KI, Subasinghe AK. Co-design of a nurse-led model of care to increase access to medical abortion and contraception in rural and regional general practice: A protocol. Aust J Rural Health 2022; 30:876-883. [PMID: 36264024 PMCID: PMC10946737 DOI: 10.1111/ajr.12937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/29/2022] Open
Abstract
PROBLEM Women in rural and regional Australia experience a number of barriers to accessing sexual and reproductive health care including lack of local services, high costs and misinformation. SETTING Nurse-led task-sharing models of care for provision of long-acting reversible contraception (LARC) and early medical abortion (EMA) are one strategy to reduce barriers and improve access to services but have yet to be developed in general practice. KEY MEASURES FOR IMPROVEMENT Through a co-design process, we will develop a nurse-led model of care for LARC and EMA provision that can be delivered through face-to-face consultations or via telehealth in rural general practice in Australia. STRATEGIES FOR CHANGE A co-design workshop, involving consumers, health professionals (particularly General Practitioners (GPs) and Practice Nurses (PNs)), GP managers and key stakeholders will be conducted to design nurse-led models of care for LARC and EMA including implant insertion by nurses. The workshop will be informed by the 'Experience-Based Co-Design' toolkit and involves participants mapping the patient journey for service provision to inform a new model of care. EFFECTS OF CHANGE Recommendations from the workshop will inform a nurse-led model of care for LARC and EMA provision in rural general practice. The model will provide practical guidance for the set-up and delivery of services. LESSONS LEARNT Nurses will work to their full scope of practice to increase accessibility of EMA and LARC in rural Australia.
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Affiliation(s)
- Jessica E. Moulton
- SPHERE, NHMRC Centre of Research Excellence, Department of General PracticeMonash UniversityNotting HillVICAustralia
| | - Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General PracticeMonash UniversityNotting HillVICAustralia
| | - Jane Tomnay
- Centre for Excellence in Rural Sexual HealthUniversity of MelbourneMelbourneVICAustralia
| | - Deborah Bateson
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
- Family Planning NSWSydneyNSWAustralia
| | - Wendy V. Norman
- Department of Family PracticeUniversity of British ColumbiaVancouverBCCanada
| | - Kirsten I. Black
- Specialty of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine and HealthUniversity of SydneySydneyNSWAustralia
| | - Asvini K. Subasinghe
- SPHERE, NHMRC Centre of Research Excellence, Department of General PracticeMonash UniversityNotting HillVICAustralia
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12
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Baraitser P, Free C, Norman WV, Lewandowska M, Meiksin R, Palmer MJ, Scott R, French R, Wellings K, Ivory A, Wong G. Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review. BMJ Open 2022; 12:e066650. [PMID: 36385017 PMCID: PMC9670095 DOI: 10.1136/bmjopen-2022-066650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To inform UK service development to support medical abortion at home, appropriate for person and context. DESIGN Realist review SETTING/PARTICIPANTS: Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion. INTERVENTIONS Interventions and new models of abortion care relevant to the UK. OUTCOME MEASURES Causal explanations, in the form of context-mechanism-outcome configurations, to test and develop our realist programme theory. RESULTS We identified 12 401 abstracts, selecting 944 for full text assessment. Our final review included 50 papers. Medical abortion at home is safe, effective and acceptable to most, but clinical pathways and user experience are variable and a minority would not choose this method again. Having a choice of abortion location remains essential, as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (appointment number, timing and wait-times), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and desire for awareness/involvement in the process. We found experiences could be improved by offering: an option for self-referral through a telemedicine consultation, realistic information on a range of experiences, opportunities to personalise the process, improved pain relief, and choice of when and how to discuss contraception. CONCLUSIONS Acknowledging the work done by patients when moving medical abortion care from clinic to home is important. Patients may benefit from support to: prepare a space, manage privacy and work/caring obligations, decide when/how to take medications, understand what is normal, assess experience and decide when and how to ask for help. The transition of this complex intervention when delivered outside healthcare environments could be supported by strategies that reduce surprise or anxiety, enabling preparation and a sense of control.
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Affiliation(s)
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Maria Lewandowska
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca Meiksin
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa J Palmer
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Scott
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rebecca French
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Alice Ivory
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
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Mazza D, Botfield JR. Opportunities for Increasing Access to Effective Contraception in Australia. Semin Reprod Med 2022; 40:240-245. [PMID: 36478566 DOI: 10.1055/s-0042-1759554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Effective contraception can prevent unintended pregnancies, however there is an unmet need for effective contraception in Australia. Despite their being a range of contraceptive methods available, access to these remains equitable and uptake of the most effective methods is low. There is an opportunity to reduce the rate of unintended pregnancies in Australia by improving the uptake of effective contraception for those who desire this. Improving access will require increasing consumer health literacy about contraception, as well as the option of telehealth as a mode of service delivery, and stronger investment in contraceptive services through appropriate reimbursement for providers. There is also a need to test new models of care to increase access to and use of effective contraception in Australia, including nurse and midwifery-led models of contraceptive care and pharmacy involvement in contraceptive counseling.
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Affiliation(s)
- Danielle Mazza
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
| | - Jessica R Botfield
- SPHERE, NHMRC Centre of Research Excellence, Department of General Practice, Monash University, Melbourne, Victoria, Australia
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Song B, Boulware A, Wong ZJ, Huang I, Whitaker AK, Hasselbacher L, Stulberg D. "This has definitely opened the doors": Provider perceptions of patient experiences with telemedicine for contraception in Illinois. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2022; 54:80-89. [PMID: 36071608 PMCID: PMC9826464 DOI: 10.1363/psrh.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
CONTEXT The COVID-19 pandemic increased the provision of contraception through telemedicine. This qualitative study describes provider perceptions of how telemedicine provision of contraception has impacted patient care. METHODS We interviewed 40 obstetrics-gynecology and family medicine physicians, midwives, nurse practitioners, and support staff providing contraception via telemedicine in practices across Illinois, including Planned Parenthood of Illinois (PPIL) health centers. We analyzed interview content to identify themes around the perceived impact of telemedicine implementation on contraception access, contraceptive counseling, patient privacy, and provision of long-acting reversible contraception (LARC). RESULTS Participants perceived that telemedicine implementation improved care by increasing contraception access, increasing focus on counseling while reducing bias, and allowing easier method switching. Participants thought disparities in telemedicine usage and limitations to the technological interface presented barriers to patient care. Participants' perceptions of how telemedicine implementation impacts patient privacy and LARC provision were mixed. Some participants found telemedicine implementation enhanced privacy, while others felt unable to ensure privacy in a virtual space. Participants found telemedicine modalities useful for counseling patients considering methods of LARC, but they sometimes presented an unnecessary extra step for those sure about receiving one at a practice offering same day insertion. CONCLUSION Providers felt telemedicine provision of contraception positively impacted patient care. Improvements to counseling and easier access to method switching suggest that telemedicine implementation may help reduce contraceptive coercion. Our findings highlight the need to integrate LARC care with telemedicine workflows, improve patient privacy protections, and promote equitable access to all telemedicine modalities.
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Affiliation(s)
- Bonnie Song
- Department of Obstetrics and GynecologyUniversity of Southern California/LAC+USC Medical CenterLos AngelesCaliforniaUSA
| | - Angel Boulware
- Department of Comparative Human DevelopmentUniversity of ChicagoChicagoIllinoisUSA
| | | | - Iris Huang
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinoisUSA
| | | | - Lee Hasselbacher
- Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health (Ci3)University of ChicagoChicagoIllinoisUSA
| | - Debra Stulberg
- Department of Family MedicineUniversity of ChicagoChicagoIllinoisUSA
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15
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Fiastro AE, Sanan S, Jacob-Files E, Wells E, Coeytaux F, Ruben MR, Bennett IM, Godfrey EM. Remote Delivery in Reproductive Health Care: Operation of Direct-to-Patient Telehealth Medication Abortion Services in Diverse Settings. Ann Fam Med 2022; 20:336-342. [PMID: 35831175 PMCID: PMC9328706 DOI: 10.1370/afm.2821] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Established models of reproductive health service delivery were disrupted by the coronavirus disease 2019 (COVID-19) pandemic. This study examines rapid innovation of remote abortion service operations across health care settings and describes the use of telehealth consultations with medications delivered directly to patients. METHODS We conducted semi-structured interviews with 21 clinical staff from 4 practice settings: family planning clinics, online medical services, and primary care practices-independent or within multispecialty health systems. Clinicians and administrators described their telehealth abortion services. Interviews were recorded, transcribed, and analyzed. Staff roles, policies, and procedures were compared across practice settings. RESULTS Across all practice settings, telehealth abortion services consisted of 5 operational steps: patient engagement, care consultations, payment, medication dispensing, and follow-up communication. Online services and independent primary care practices used asynchronous methods to determine eligibility and complete consultations, resulting in more efficient services (2-5 minutes), while family planning and health system clinics used synchronous video encounters requiring 10-30 minutes of clinician time. Family planning and health system primary care clinics mailed medications from clinic stock or internal pharmacies, while independent primary care practices and online services often used mail-order pharmacies. Online services offered patients asynchronous follow-up; other practice settings scheduled synchronous appointments. CONCLUSIONS Rapid innovations implemented in response to disrupted in-person reproductive health care included remote medication abortion services with telehealth assessment/follow-up and mailed medications. Though consistent operational steps were identified across health care settings, variation allowed for adaptation of services to individual sites. Understanding remote abortion service operations may facilitate dissemination of a range of patient-centered reproductive health services.Annals "Online First" article.
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Affiliation(s)
- Anna E Fiastro
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Sajal Sanan
- Department of Family Medicine, University of Washington, Seattle, Washington
| | | | | | | | - Molly R Ruben
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Emily M Godfrey
- Department of Family Medicine, University of Washington, Seattle, Washington
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Reynolds-Wright JJ, Boydell N, Cameron S, Harden J. A qualitative study of abortion care providers' perspectives on telemedicine medical abortion provision in the context of COVID-19. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:199-204. [PMID: 34848554 PMCID: PMC8635885 DOI: 10.1136/bmjsrh-2021-201309] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 11/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Telemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs). METHODS Qualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically. RESULTS We present three themes from our qualitative analysis: (1) Selective use of ultrasound - the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues - in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation - telephone consultations were considered more focused than in-person consultations and formed only part of the overall 'package' of information provided to patients, supplemented by online and written information. CONCLUSIONS ACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.
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Affiliation(s)
- John Joseph Reynolds-Wright
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Chalmers Centre, NHS Lothian, Edinburgh, UK
| | - Nicola Boydell
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Sharon Cameron
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
- Chalmers Centre, NHS Lothian, Edinburgh, UK
| | - Jeni Harden
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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Peña M, Flores KF, Ponce MM, Serafín DF, Camarillo Zavala AM, Cruz CR, Salgado IGO, Rosado YO, Socarras T, López AP, Bousiéguez M. Telemedicine for medical abortion service provision in Mexico: A safety, feasibility, and acceptability study. Contraception 2022; 114:67-73. [PMID: 35753406 DOI: 10.1016/j.contraception.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to obtain evidence about the safety, acceptability, and feasibility of a direct-to-patient telemedicine medical abortion service in Mexico's private health sector. STUDY DESIGN A prospective observational one-group study to evaluate a telemedicine abortion service, referred to as TeleAborto, was conducted at three private clinics and one non-clinician community-based provider. Information about the study was provided by phone, websites, and social media. Abortion seekers were screened for eligibility and underwent any pre-abortion tests requested by the study site at services close to home. Eligible participants received packages with abortion medication, analgesics, and instructions and a remote follow-up contact was scheduled for 7-14 days later. Primary outcomes include abortion outcome, management of adverse events, acceptability, and feasibility measures such as package reception and follow-up contact, and challenges to get pre- and post-abortion tests. RESULTS We conducted 581 screenings and sent 378 study packages, all successfully received, reaching abortion seekers in all 32 states. All participants took medications before 70 days gestational age as per study protocol. Abortion outcome was determined for 87% participants (330/378); 93% (306/330) had a successful abortion without intervention and 18 with intervention; six individuals decided to continue the pregnancy. Participants reported high satisfaction with TeleAborto, citing convenience as their most valued aspect (85%; 264/311). CONCLUSIONS This study showed that guided self-management telemedicine abortion is safe, acceptable, and feasible in Mexico. The model has the potential to close the access gap for indigenous and rural populations, particularly those that rely on public sector services.
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Affiliation(s)
- Melanie Peña
- Gynuity Health Projects: 220 East 42nd Street, New York, New York 10017, United States
| | - Karla Figueroa Flores
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Mariana Muñoz Ponce
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Diana Facio Serafín
- Gineclinic: Calz. Sta. Anita 148-b, Viaducto Piedad, Iztacalco, 08200 Ciudad de México, Mexico
| | - Ana María Camarillo Zavala
- Centro de Atención Integral a la Pareja, A.C: Av. Canal de Miramontes # 2342, Coapa, Avante, Coyoacán, 04460 Ciudad de México, Mexico
| | - César Ruiz Cruz
- Medieg: Gabriel Mancera # 803, Col del Valle Centro, Benito Juárez, 03100 Ciudad de México, Mexico
| | | | - Yeni Ochoa Rosado
- Red de Mujeres y Hombres por una Opinión Pública con Perspectiva de Género en Campeche (RedMyH): Calle 55, # 14 int. 2 (entre calle 12 y calle 14) Col. Centro, Campeche, Campeche, Mexico
| | - Tania Socarras
- Planned Parenthood Global: 123 William Street, 10th floor, New York, New York 10038, United States
| | - Adrián Pacheco López
- Centro Nacional de Excelencia Tecnológica en Salud (CENETEC): 450 -13, Juárez, Cuauhtémoc, 06600 Ciudad de México, Mexico
| | - Manuel Bousiéguez
- Gynuity Health Projects: 220 East 42nd Street, New York, New York 10017, United States
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Matulich MC, Hou MY, Chen MJ, Uhm S, Creinin MD. Implementation of telemedicine preoperative visits for abortion procedures through 18 weeks gestation at a Northern California hospital-based center. Contraception 2022; 114:74-78. [PMID: 35750146 DOI: 10.1016/j.contraception.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Describe the implementation of a preoperative telemedicine program at a Northern California hospital-based center for abortion procedures requiring cervical preparation. STUDY DESIGN We implemented a pilot program using telemedicine for preoperative visits for patients needing cervical preparation prior to an abortion procedure from 12 to 18 weeks. We required ultrasonography for gestational age documentation in addition to placental localization in patients with a prior cesarean delivery. We prescribed misoprostol for cervical preparation for patients undergoing the telemedicine preoperative visit; in-person preoperative visits typically involve placement of osmotic dilators. Secondarily, we surveyed patients who had telemedicine and in-person preoperative visits to compare their preoperative experiences. RESULTS Implementation required eight months of multidisciplinary meetings. From March 2018 through March 2019, we received 200 abortion referrals at 12 to 18 weeks gestation. Of these 200 patients, 119 did not meet telemedicine eligibility criteria, most commonly due to inability to obtain required ultrasonography (n=89 [75%]). Of the remaining 81 patients, 43 scheduled telemedicine visits of which 41 initiated and 38 (88%) completed the visits. Twenty-one (55%) telemedicine encounters had no or minor technical difficulties. Thirty-one of 34 (91%) telemedicine and 91 of 108 (84%) in-person visit patients expressed high satisfaction with their preoperative appointment (p=0.4); none reported dissatisfaction. Patients chose the telemedicine visit primarily for convenience and transportation concerns. CONCLUSION A multidisciplinary team is essential for the successful implementation of a preoperative telemedicine program for procedural abortion care. Patients reported high satisfaction and reduced logistical burdens with the telemedicine option. IMPLICATIONS Telemedicine preoperative visits for abortion procedures at 12-18 weeks gestation may improve access to abortion care, reduce patient burdens, and provide an alternative encounter option which may improve the patient experience.
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Affiliation(s)
- Melissa C Matulich
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA.
| | - Melody Y Hou
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA
| | - Melissa J Chen
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA
| | - Suji Uhm
- Current institution: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh/Magee-Womens Hospital, Pittsburgh, PA
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis; Sacramento, CA
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Bercu C, Filippa S, Ramirez AM, Katz A, Grosso B, Zurbriggen R, Vázquez S, Baum SE. Perspectives on high-quality interpersonal care among people obtaining abortions in Argentina. Reprod Health 2022; 19:107. [PMID: 35501904 PMCID: PMC9059438 DOI: 10.1186/s12978-022-01401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 03/24/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Little is known about how people who have abortions describe high-quality interpersonal care in Argentina. This qualitative study aimed to understand preferences and priorities in their interactions with providers. Study design We conducted 24 in-depth interviews with people who obtained abortions at a comprehensive reproductive health clinic or with support from a feminist accompaniment group in Buenos Aires and Neuquén, Argentina. We iteratively coded transcripts using a thematic analysis approach based on interpersonal domains present in current quality of care frameworks. Results Participants described high-quality abortion care as feeling acompañamiento and contención from their providers – terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortion. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. Conclusions People obtaining abortions in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people’s perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01401-1. Little is known about how people who have abortions perceive the quality of the care they receive and what aspects of interpersonal interactions with providers matter to them. This qualitative study aimed to understand preferences of people who had abortions at both a reproductive health clinic and with an accompaniment group in Argentina. We interviewed 24 people who obtained abortion care in Buenos Aires and Neuquén, Argentina. We asked them about their preferences for and experiences of abortion care. Then we analyzed the interviews, specifically assessing aspects of interpersonal care based on quality of care frameworks from the literature. Participants described high-quality abortion care as feeling acompañamiento and contención from their providers—terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortions. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. In conclusion, people obtaining abortions in two distinct models of care in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating people’s perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion.
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Melville C. Abortion care in Australasia: A matter of health, not politics or religion. Aust N Z J Obstet Gynaecol 2022; 62:187-189. [PMID: 35482706 DOI: 10.1111/ajo.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
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Thompson TA, Seymour JW, Melville C, Khan Z, Mazza D, Grossman D. An observational study of patient experiences with a direct-to-patient telehealth abortion model in Australia. BMJ SEXUAL & REPRODUCTIVE HEALTH 2022; 48:103-109. [PMID: 34531258 DOI: 10.1136/bmjsrh-2021-201259] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND While abortion care is widely legal in Australia, access to care is often poor. Many Australians must travel long distances or interstate to access abortion care, while others face stigma when seeking care. Telehealth-at-home medical abortion is a potential solution to these challenges. In this study, we compared the experience of accessing an abortion via telehealth-at-home to accessing care in-clinic. METHODS Over a 20-month period, we surveyed patients who received medical abortion services at Marie Stopes Australia via the telehealth-at-home service or in-clinic. We conducted bivariate analyses to assess differences in reported acceptability and accessibility by delivery model. RESULTS In total, 389 patients were included in the study: 216 who received medical abortion services in-clinic and 173 through the telehealth-at-home service. Telehealth-at-home and in-clinic patients reported similarly high levels of acceptability: satisfaction with the service (82% vs 82%), provider interaction (93% vs 84%), and recommending the service to a friend (73% vs 72%). Only 1% of telehealth-at-home patients reported that they would have preferred to be in the same room as the provider. While median time between discovering the pregnancy to first contact with a clinic was similar between groups, median time from first contact to taking the first abortion medication was 7 days longer for telehealth-at-home patients versus in-clinic patients (14 days (IQR 9-21) vs 7 days (IQR 4-14); p<0.01). CONCLUSION The telehealth-at-home medical abortion service has the potential to address some of the challenges with provision of abortion care in Australia.
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Affiliation(s)
| | | | | | - Zara Khan
- The University of Texas Southwestern Medical Center Medical School, Dallas, Texas, USA
| | - Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, Oakland, California, USA
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22
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Thompson TA, Northcraft D, Carrión F. Addressing Structural Inequities, a Necessary Step Toward Ensuring Equitable Access to Telehealth for Medication Abortion Care During and Post COVID-19. Front Glob Womens Health 2022; 3:805767. [PMID: 35368993 PMCID: PMC8967978 DOI: 10.3389/fgwh.2022.805767] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Telehealth, one of the newest health innovations, has been promoted as a tool to enhance access to health care services in ways that center patient needs. However, integrating telehealth within an inequitable health system undermines its potential. This perspective highlights policies and practices that foster structural inequities and names their impact on the use and acceptability of telehealth for medication abortion among specific communities of color. Communities of color have a higher prevalence of abortion use but face many barriers, including financial and geographic barriers, to abortion access. Preliminary evidence on telehealth for medication abortion shows that it is highly acceptable, accommodating of patient needs, and may allow patients to access abortion care at earlier gestational ages. However, evidence during the COVID-19 pandemic shows that utilization of telehealth is lower among communities of color. We describe how systemic barriers, including regulations on or laws banning telehealth for medication abortion, disinvestments in digital access, and restrictions on public insurance coverage, could perpetuate lower utilization of telehealth for medication abortion care among communities of color. We call for systems changes that will remove these barriers and make this health care innovation available to all who may desire it.
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Affiliation(s)
| | - Dana Northcraft
- Expanding Medication Abortion Access (EMAA) Project, Washington, DC, United States
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Mazza D, Seymour JW, Sandhu MV, Melville C, O Rsquo Brien J, Thompson TA. General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision. Aust J Prim Health 2021; 27:456-461. [PMID: 34782057 DOI: 10.1071/py20297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/16/2021] [Indexed: 11/23/2022]
Abstract
In Australia, there are many barriers to abortion, particularly for women living in regional, rural and remote areas. Telehealth provision of medical abortion is safe, effective and acceptable to patients and providers. In 2015, Marie Stopes Australia (MSA) launched an at-home telehealth model for medical abortion to which GPs could refer. Between April and November of 2017, we interviewed 20 GPs who referred patients to MSA's telehealth-at-home abortion service to better understand their experiences and perspectives regarding telehealth-at-home abortion. We found that there was widespread support and recognition of the benefits of telehealth-at-home abortion in increasing access to abortion and reducing travel and costs. However, the GPs interviewed lacked knowledge and understanding of the processes involved in medical abortion, and many were unaware of the availability of telehealth as an option until a patient requested a referral. The GPs interviewed called for increased communication between telehealth-at-home abortion providers and GPs. Increasing GP familiarity with medical abortion and awareness of the availability of telehealth-at-home abortion may assist people in accessing safe, effective medical abortion.
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Affiliation(s)
- Danielle Mazza
- Department of General Practice, Monash University, Notting Hill, Vic. 3168, Australia
| | | | | | | | | | - Terri-Ann Thompson
- Ibis Reproductive Health, Cambridge, MA 02140, USA; and Corresponding author.
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Mazza D. Increasing access to women's sexual and reproductive health services: telehealth is only the start. Med J Aust 2021; 215:352-353. [PMID: 34510470 DOI: 10.5694/mja2.51258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
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Subasinghe AK, McGeechan K, Moulton JE, Grzeskowiak LE, Mazza D. Early medical abortion services provided in Australian primary care. Med J Aust 2021; 215:366-370. [PMID: 34553385 DOI: 10.5694/mja2.51275] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine primary care provision of early medical abortion services in Australia. DESIGN Cross-sectional study; analysis of Pharmaceutical Benefits Scheme (PBS) dispensing data. SETTING, PARTICIPANTS Women of child-bearing age (15-54 years), Australia, 2015-2019. MAIN OUTCOME MEASURES Age-standardised rates of MS-2 Step prescriptions dispensed by year for 2015-2019, and age-standardised rates by state, remoteness area, and level 3 statistical areas (SA3s) for 2019. Numbers and proportions of SA3s in which MS-2 Step was not prescribed by a GP or dispensed by a community pharmacy during 2019 (unweighted and weighted by number of women of reproductive age), by state and remoteness area. RESULTS During 2015-2019, 91 643 PBS prescriptions for MS-2 Step were dispensed; the national age-standardised rate increased from 1.63 in 2015 to 3.79 prescriptions per 1000 women aged 15-54 years in 2019. In 2019, rates were higher in outer regional Australia (6.53 prescriptions per 1000 women aged 15-54 years) and remote Australia (6.02 per 1000) than in major cities (3.30 per 1000). However, about 30% of women in Australia lived in SA3s in which MS-2 Step had not been prescribed by a GP during 2019, including about 50% of those in remote Australia. CONCLUSIONS The rate of early medical abortion is greater among women in remote, outer regional, and inner regional Australia than in major cities, but a considerable proportion of women live in areas in which MS-2 Step was not locally prescribed or dispensed during 2019. Supporting GPs in the delivery of early medical abortion services locally should be a focus of health policy.
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Affiliation(s)
| | | | | | - Luke E Grzeskowiak
- Flinders University, Adelaide, SA.,South Australian Health and Medical Research Institute, Adelaide, SA
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26
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Porter Erlank C, Lord J, Church K. Acceptability of no-test medical abortion provided via telemedicine during Covid-19: analysis of patient-reported outcomes. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:261-268. [PMID: 33602718 PMCID: PMC7977074 DOI: 10.1136/bmjsrh-2020-200954] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 05/23/2023]
Abstract
INTRODUCTION The English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks' gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA. METHODS A sample of all MSUK's telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure. RESULTS Patients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue. CONCLUSIONS Telemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.
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Affiliation(s)
| | - Jonathan Lord
- Medical Director, MSI Reproductive Choices, London, UK
- Truro Locality, University of Exeter Medical School, Truro, Cornwall, UK
| | - Kathryn Church
- Evidence to Action Department, MSI Reproductive Choices, London, UK
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27
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Abstract
PURPOSE OF REVIEW The COVID-19 pandemic has highlighted existing healthcare disparities worldwide and has challenged access to family planning (FP) services. RECENT FINDINGS Research has identified ways in which government regulations and healthcare programs have inhibited or increased access to FP services, as well as how the pandemic has changed individuals' sexual and reproductive health behaviors and intentions. SUMMARY The pandemic has had both positive and negative effects on access to FP services. Innovations in various delivery services, extended use of contraception, telehealth for medication abortion, and a no-test medication abortion protocol have decreased the need for in-person visits and improved access to FP services.
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Affiliation(s)
- Taylor Stanton
- Department of Obstetrics & Gynecology, Stanford University, Palo Alto, California, USA
| | - Deborah Bateson
- Family Planning NSW, Faculty of Medicine and Health, Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, Australia
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Cheng Y, Boerma C, Peck L, Botfield JR, Estoesta J, McGeechan K. Telehealth sexual and reproductive health care during the COVID-19 pandemic. Med J Aust 2021; 215:371-372. [PMID: 34374090 PMCID: PMC8447060 DOI: 10.5694/mja2.51219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Lucy Peck
- Family Planning NSW, Sydney, NSW.,The University of Sydney, Sydney, NSW
| | | | | | - Kevin McGeechan
- Family Planning NSW, Sydney, NSW.,The University of Sydney, Sydney, NSW
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Chong E, Shochet T, Raymond E, Platais I, Anger HA, Raidoo S, Soon R, Grant MS, Haskell S, Tocce K, Baldwin MK, Boraas CM, Bednarek PH, Banks J, Coplon L, Thompson F, Priegue E, Winikoff B. Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic. Contraception 2021; 104:43-48. [PMID: 33781762 PMCID: PMC9748604 DOI: 10.1016/j.contraception.2021.03.019] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To present updated evidence on the safety, efficacy and acceptability of a direct-to-patient telemedicine abortion service and describe how the service functioned during the COVID-19 pandemic. STUDY DESIGN We offered the study at 10 sites that provided the service in 13 states and Washington DC. Interested individuals obtained any needed preabortion tests locally and had a videoconference with a study clinician. Sites sent study packages containing mifepristone and misoprostol by mail and had remote follow-up consultations within one month by telephone (or by online survey, if the participant could not be reached) to evaluate abortion completeness. The analysis was descriptive. RESULTS We mailed 1390 packages between May 2016 and September 2020. Of the 83% (1157/1390) of abortions for which we obtained outcome information, 95% (1103/1157) were completed without a procedure. Participants made 70 unplanned visits to emergency rooms or urgent care centers for reasons related to the abortion (6%), and 10 serious adverse events occurred, including 5 transfusions (0.4%). Enrollment increased substantially with the onset of COVID-19. Although a screening ultrasound was required, sites determined in 52% (346/669) of abortions that occurred during COVID that those participants should not get the test to protect their health. Use of urine pregnancy test to confirm abortion completion increased from 67% (144/214) in the 6 months prior to COVID to 90% (602/669) in the 6 months during COVID. Nearly all satisfaction questionnaires (99%, 1013/1022) recorded that participants were satisfied with the service. CONCLUSIONS This direct-to-patient telemedicine service was safe, effective, and acceptable, and supports the claim that there is no medical reason for mifepristone to be dispensed in clinics as required by the Food and Drug Administration. In some cases, participants did not need to visit any facilities to obtain the service, which was critical to protecting patient safety during the COVID-19 pandemic. IMPLICATIONS Medical abortion using telemedicine and mail is effective and can be safely provided without a pretreatment ultrasound. This method of service delivery has the potential to greatly improve access to abortion care in the United States.
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Affiliation(s)
- Erica Chong
- Gynuity Health Projects, New York, NY, USA,Present address: Reproductive Health Education in Family Medicine, 3544 Jerome Avenue, Bronx, NY 10467.,Corresponding author
| | | | | | | | | | - Shandhini Raidoo
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | - Reni Soon
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, Honolulu, HI, USA
| | | | - Susan Haskell
- carafem, 1001 Connecticut Avenue NW, Washington, DC, USA
| | - Kristina Tocce
- Planned Parenthood of the Rocky Mountains, Denver, CO, USA
| | | | | | | | - Joey Banks
- Planned Parenthood of Montana, Missoula, MT, USA
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30
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Boydell N, Reynolds-Wright JJ, Cameron ST, Harden J. Women's experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID-19) pandemic: a qualitative evaluation. BJOG 2021; 128:1752-1761. [PMID: 34138505 PMCID: PMC8441904 DOI: 10.1111/1471-0528.16813] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
Objective To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision. Design Qualitative interview study. Setting Abortion service in one National Health Service health board in Scotland. Population or sample Twenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation. Methods Thematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach. Main outcome measures Women’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home. Results Novel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan. Conclusions This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service. Tweetable abstract #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher. #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher. This article includes Author Insights, a video abstract available at: https://vimeo.com/bjog/authorinsights16813
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Affiliation(s)
- N Boydell
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - J J Reynolds-Wright
- NHS Lothian, Edinburgh, UK.,MRC Centre for Reproductive Healthcare, University of Edinburgh, Edinburgh, UK
| | - S T Cameron
- NHS Lothian, Edinburgh, UK.,MRC Centre for Reproductive Healthcare, University of Edinburgh, Edinburgh, UK
| | - J Harden
- Usher Institute, University of Edinburgh, Edinburgh, UK
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31
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Kaller S, Daniel S, Raifman S, Biggs MA, Grossman D. Pre-Abortion Informed Consent Through Telemedicine vs. in Person: Differences in Patient Demographics and Visit Satisfaction. Womens Health Issues 2021; 31:227-235. [PMID: 33832830 DOI: 10.1016/j.whi.2021.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Utah law requires patients to have a face-to-face "informed consent" visit at least 72 hours prior to abortion. Planned Parenthood Association of Utah (PPAU) offers this visit via telemedicine as an alternative to an in-person visit, which can require burdensome travel. This novel study identifies factors associated with using telemedicine for informed consent, patients' reasons for using it, and experiences with it, compared to in-person informed consent. METHODS In 2017 and 2018, patients 18 years and older seeking abortion at PPAU completed a self-administered online survey about their experiences with the informed consent visit. We used linear and logistic regression models to compare participants' demographic characteristics by informed consent visit type, and descriptive statistics to describe reasons for using each visit type and experiences with the visit. Multivariable logistic regression models examined associations between visit type and satisfaction. RESULTS Responses from 166 telemedicine patients and 217 in-person informed consent patients indicate that telemedicine participants would have had to travel significantly further than in-person participants traveled to attend the visit at the clinic (mean of 65 miles versus 21 miles, p < .001). In multivariable analyses, telemedicine participants had higher odds of being "very satisfied" with the visit (aOR, 2,89; 95% CI: 1.93-4.32) and "very comfortable" asking questions during the visit (aOR, 3.76; 95% CI: 2.58-5.49), compared to participants who attended in-person visits. CONCLUSIONS Telemedicine offers a convenient, acceptable option for mandated pre-abortion informed consent visits and reduces the burden of additional travel and associated barriers for some patients, particularly those who live further away from clinics.
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Affiliation(s)
- Shelly Kaller
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, Oakland, California.
| | - Sara Daniel
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, Oakland, California
| | - Sarah Raifman
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, Oakland, California
| | - M Antonia Biggs
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, Oakland, California
| | - Daniel Grossman
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, Oakland, California
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Gibelin K, Agostini A, Marcot M, Piclet H, Bretelle F, Miquel L. COVID-19 impact in abortions' practice, a regional French evaluation. J Gynecol Obstet Hum Reprod 2020; 50:102038. [PMID: 33307242 PMCID: PMC7836690 DOI: 10.1016/j.jogoh.2020.102038] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/02/2022]
Abstract
INTRODUCTION On March 14, 2020, France has entered into stage 3 of the COVID-19 pandemic. The French National Health Agency (Haute Autorité de Santé) has urgently recommended the use of medical abortion at home between 7 and 9 weeks of gestation and telemedicine for medical abortion consultations. The main objective of this study was to assess whether the emergency measures undertaken for the management of abortions during the COVID-19 pandemic led to practice changes, and to obtain practitioners' opinions regarding the continuation of these measures. MATERIAL AND METHODS This was a retrospective, quantitative, online self-administered survey from August 6, 2020 to October 2, 2020, aimed at health workers performing abortions (midwives, general practitioners, gynecologists obstetricians and medical gynecologists) in the South and Corse regions in France. RESULTS Among the 124 practitioners included, 59/77 (76.6 %) offered medical abortion at home between 7 and 9 weeks of gestation and 61/89 (68.5 %) of them wished to carry on this practice. 55/123 (44.7 %) practitioners offered telemedicine for medical abortion at home and 71/115 (61.7 %) of them wished to carry on this practice. DISCUSSION The emergency measures implemented by the the French National Health Agency (Haute Autorité de Santé) for medical abortion are approved and followed by the majority of health workers performing abortions in the South and Corse regions. This measure may be extended out of the COVID-19 epidemic.
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Affiliation(s)
- Karen Gibelin
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France
| | - Aubert Agostini
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France
| | - Michèle Marcot
- Méditerranean Network, Périnatality South and Corse, Network, 13015, Marseille, France
| | - Hélène Piclet
- Department of Gynecology, Obstetrics and Reproductive Medicine, Pôle Femmes Parents Enfants, AP-HM Hôpital Nord University Hospital, Chemin des Bourrely, 13015, Marseille, France
| | - Florence Bretelle
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France; Department of Gynecology, Obstetrics and Reproductive Medicine, Pôle Femmes Parents Enfants, AP-HM Hôpital Nord University Hospital, Chemin des Bourrely, 13015, Marseille, France
| | - Laura Miquel
- Department of Obstetrics, Gynecology and Reproductive Medicine, Pôle Femmes Parents Enfants, AP-HM La Conception University Hospital, 147 bd Baille, 13005, Marseille, France.
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33
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Melville C. Digital provision of sexual and reproductive healthcare: promising but not a panacea. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:239-241. [PMID: 32883684 DOI: 10.1136/bmjsrh-2020-200668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 06/11/2023]
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34
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Norman WV, Munro S. Let's keep our eye on the ball. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:159-160. [PMID: 32665230 PMCID: PMC7392478 DOI: 10.1136/bmjsrh-2020-200703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Wendy V Norman
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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