Formerly of the Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, United States.
Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, United States.
Sex Reprod Healthc. 2019 Oct;21:102-107. doi: 10.1016/j.srhc.2019.07.001. Epub 2019 Jul 15.
Many patients may wish to receive contraceptive counseling and services during an abortion visit, but a 2009 study documented challenges faced by abortion clinics, especially independent ones, in providing contraceptive care. Since then, the Affordable Care Act (ACA) has made contraception more accessible by expanding coverage to millions of individuals and by eliminating out of pocket costs. This paper aims to update this previous work and describe recent challenges in providing contraceptive care in independent abortion settings following the ACA, as well as the strategies used to address these challenges.
We conducted two focus groups and 19 semi-structured interviews with clinic administrators and directors at independent abortion clinics.
Challenges to providing contraceptive care in independent abortion clinics included navigating new guidelines under the Affordable Care Act for establishing coverage agreements with health insurance plans and receiving timely and sufficient reimbursement for services provided. Study respondents described strategies related to adjusting clinic flow and protocols to address patient needs regarding receiving contraception during abortion care.
Staff working in independent abortion clinics in the United States experience a tension between trying to provide holistic, patient-centered care - including contraceptive care - and navigating restrictive political and healthcare contexts for the delivery of abortion care.
许多患者可能希望在堕胎就诊期间接受避孕咨询和服务，但 2009 年的一项研究记录了堕胎诊所，尤其是独立堕胎诊所在提供避孕护理方面面临的挑战。自那时以来，《平价医疗法案》（ACA）通过向数百万个人扩大覆盖范围并消除自付费用，使避孕措施更容易获得。本文旨在更新之前的工作，并描述在 ACA 之后独立堕胎环境中提供避孕护理的最新挑战，以及为解决这些挑战而采用的策略。
我们对独立堕胎诊所的诊所管理人员和主任进行了两次焦点小组讨论和 19 次半结构化访谈。
在独立堕胎诊所提供避孕护理的挑战包括根据《平价医疗法案》的新准则与健康保险计划建立覆盖协议，并及时获得提供服务的充分报销。研究受访者描述了与调整诊所流程和协议相关的策略，以满足患者在堕胎护理期间接受避孕的需求。
在美国，独立堕胎诊所的工作人员在试图提供整体、以患者为中心的护理（包括避孕护理）与为堕胎护理提供服务的限制性政治和医疗保健环境之间存在紧张关系。
