Society of Family Planning and Society of Family Planning Research Fund, Denver, CO, United States.
Society of Family Planning and Society of Family Planning Research Fund, Denver, CO, United States.
Contraception. 2021 Jul;104(1):77-81. doi: 10.1016/j.contraception.2021.04.010. Epub 2021 Apr 21.
To document medication abortion clinical practice changes adopted by providers in response to the COVID-19 pandemic.
Longitudinal descriptive study, comprised of three online surveys conducted between April to December, 2020. We recruited sites from email lists of national abortion and family planning organizations.
Seventy-four sites opted to participate. We analyzed 55/74 sites (74%) that provided medication abortion and completed all three surveys. The total number of abortion encounters reported by the sites remained consistent throughout the study period, though medication abortion encounters increased while first-trimester aspiration abortion encounters decreased. In response to the COVID-19 pandemic, sites reduced the number of in-person visits associated with medication abortion and confirmation of successful termination. In February 2020, considered prepandemic, 39/55 sites (71%) required 2 or more patient visits for a medication abortion. By April 2020, 19/55 sites (35%) reported reducing the total number of in-person visits associated with a medication abortion. As of October 2020, 37 sites indicated newly adopting a practice of offering medication abortion follow-up with no in-person visits.
Sites quickly adopted protocols incorporating practices that are well-supported in the literature, including forgoing Rh-testing and pre-abortion ultrasound in some circumstances and relying on patient report of symptoms or home pregnancy tests to confirm successful completion of medication abortion. Importantly, these practices reduce face-to-face interactions and the opportunity for virus transmission. Sustaining these changes even after the public health crisis is over may increase patient access to abortion, and these impacts should be evaluated in future research.
Medication abortion serves a critical function in maintaining access to abortion when there are limitations to in-person clinic visits. Sites throughout the country successfully and quickly adopted protocols that reduced visits associated with the abortion, reducing in-person screenings, relying on telehealth, and implementing remote follow-up.
记录提供者为应对 COVID-19 大流行而采取的药物流产临床实践变化。
纵向描述性研究，由 2020 年 4 月至 12 月期间进行的三次在线调查组成。我们从全国堕胎和计划生育组织的电子邮件列表中招募了研究点。
74 个站点选择参与。我们分析了 74 个提供药物流产并完成了所有三次调查的 55/74 个站点（74%）。报告的堕胎就诊次数在整个研究期间保持不变，尽管药物流产就诊次数增加，而第一孕期抽吸流产就诊次数减少。为应对 COVID-19 大流行，站点减少了与药物流产和确认终止成功相关的面对面就诊次数。在 2020 年 2 月，即大流行前，55 个站点中的 39 个（71%）需要 2 次或更多次就诊才能进行药物流产。到 2020 年 4 月，55 个站点中的 19 个（35%）报告减少了与药物流产相关的总面对面就诊次数。截至 2020 年 10 月，37 个站点表示新采用了不进行面对面随访的药物流产后处理实践。
站点迅速采用了符合文献支持的实践方案，包括在某些情况下放弃 Rh 检测和堕胎前超声检查，并依靠患者报告症状或家庭妊娠试验来确认药物流产的成功完成。重要的是，这些实践减少了面对面的互动和病毒传播的机会。即使在公共卫生危机结束后，维持这些变化也可能会增加患者获得堕胎的机会，未来的研究应评估这些影响。
当面对面就诊受到限制时，药物流产在维持堕胎服务方面发挥着至关重要的作用。全国各站点成功且迅速地采用了减少与堕胎相关就诊次数的方案，减少了面对面筛查，依靠远程医疗，并实施了远程随访。
