Department of Family Medicine, University of Washington, Washington, WA, United States.
Department of Family Medicine, University of Washington, Washington, WA, United States.
Contraception. 2021 Jul;104(1):82-91. doi: 10.1016/j.contraception.2021.04.021. Epub 2021 Apr 29.
To overcome obstacles to delivering medication abortion services during the COVID-19 pandemic, clinics and providers implemented new medication abortion service models not requiring in-person care. This study identifies organizational factors that promoted successful implementation of telehealth and adoption of "no test" medication abortion protocols.
We conducted 21 semi-structured, in-depth interviews with health care providers and clinic administrators implementing clinician-supported telehealth abortion during the COVID pandemic. We selected 15 clinical sites to represent 4 different practice settings: independent primary care practices, online medical services, specialty family planning clinics, and primary care clinics within multispecialty health systems. The Consolidated Framework for Implementation Research guided our thematic analysis.
Successful implementation of telehealth abortion included access to formal and informal inter-organizational networks, including professional organizations and informal mentorship relationships with innovators in the field; organizational readiness for implementation, such as having clinic resources available for telehealth services like functional electronic health records and options for easy-to-use virtual patient-provider interactions; and motivated and effective clinic champions.
In response to the need to offer remote clinical services, 4 different practice settings types leveraged key operational factors to facilitate successful implementation of telehealth abortion. Information from this study can inform implementation strategies to support the dissemination and adoption of this model.
Examples of successfully implemented telehealth medication abortion services provide a framework that can be used to inform and implement similar patient-centered telehealth models in diverse practice settings.
为了克服在 COVID-19 大流行期间提供药物流产服务的障碍，诊所和提供者实施了新的药物流产服务模式，无需亲自护理。本研究确定了促进远程医疗成功实施和采用“无需检测”药物流产方案的组织因素。
我们对在 COVID 大流行期间实施医生支持的远程医疗堕胎的医疗保健提供者和诊所管理人员进行了 21 次半结构化深入访谈。我们选择了 15 个临床站点，代表 4 种不同的实践环境：独立的初级保健实践、在线医疗服务、专业计划生育诊所和多专业医疗系统内的初级保健诊所。实施研究的综合框架指导了我们的主题分析。
远程医疗堕胎的成功实施包括获得正式和非正式的组织间网络，包括专业组织和与该领域创新者的非正式指导关系；实施的组织准备，例如拥有远程医疗服务的功能电子健康记录和易于使用的虚拟患者-提供者交互选项等诊所资源；以及有动力和有效的诊所拥护者。
为了提供远程临床服务，4 种不同的实践环境类型利用关键运营因素促进了远程医疗堕胎的成功实施。本研究提供的信息可以为支持该模型的传播和采用提供实施策略。
成功实施远程医疗药物流产服务的例子为在不同实践环境中提供以患者为中心的类似远程医疗模型提供了一个框架。
