Reynolds-Wright John Joseph, Boydell Nicola, Cameron Sharon, Harden Jeni
MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
Chalmers Centre, NHS Lothian, Edinburgh, UK.
BMJ Sex Reprod Health. 2022 Jul;48(3):199-204. doi: 10.1136/bmjsrh-2021-201309. Epub 2021 Nov 30.
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).
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.
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.
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.
为应对新冠疫情，远程医疗用于药物流产护理在英国迅速推行。越来越多的文献表明，远程医疗流产护理是安全、有效的，且患者高度认可。关于流产护理提供者（ACP）的观点，我们了解得较少。
对英国 Lothian（爱丁堡及周边地区）远程医疗流产服务进行定性研究。我们在2020年5月至7月期间对 ACP 进行了定性深入访谈（医生，n = 6；护士，n = 10），并对数据进行了主题分析。
我们在定性分析中呈现了三个主题：（1）超声的选择性使用——不再常规使用超声来确定孕周这一转变总体上得到了积极看待。一些 ACP 最初对无法检测到异位妊娠和孕周较大的情况表示担忧，但通过临床实践和诊所内的支持结构，这些担忧得到了解决。（2）识别保障问题——在没有视觉线索的情况下，一些 ACP 报告担心自己识别保障问题的能力，特别是家庭暴力问题。相反，人们承认远程会诊在某些情况下可能会改善对此类问题的检测。（3）会诊期间提供信息——电话会诊被认为比面对面会诊更有针对性，并且只是提供给患者的整体“信息包”的一部分，还辅以在线和书面信息。
提供远程医疗流产护理的 ACP 重视为患者提供的这一选择，并认为在新冠疫情之后也应继续保留。保障患者安全和超声的选择性使用最初可能具有挑战性；然而，随着经验的积累，工作人员的信心会增强。
