Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, 550 16th Street, 3rd floor, San Francisco, CA, 94143, USA.
Deloitte, Portland, OR, USA.
Reprod Health. 2022 Apr 22;19(1):99. doi: 10.1186/s12978-022-01388-9.
Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care, curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). To better understand how reproductive health providers adapted service provision during the pandemic, this study assessed clinical practice changes and strategies providers adopted throughout the United States to maintain contraceptive care, particularly when clinics closed on-site, and the challenges that remained in offering contraceptive services, especially to marginalized patient populations.
We surveyed U.S. providers and clinic staff (n = 907) in April 2020-January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. We assessed clinical practice changes with multivariate regression analyses using generalized linear models with a Poisson distribution and cluster robust standard errors, adjusting for clinic patient volume, practice setting, region, Title X funding, and time of survey.
While 80% of providers reported their clinic remained open, 20% were closed on-site. Providers said the pandemic made it more difficult to offer the full range of contraceptive methods (65%), contraceptive counseling (61%) or to meet the needs of patients in marginalized communities (50%). While only 11% of providers offered telemedicine pre-pandemic, most offered telemedicine visits (79%) during the pandemic. Some used mail-order pharmacies (35%), curbside contraceptive services (22%), and DMPA-SQ for self-administration (10%). Clinics that closed on-site were more likely to use mail-order pharmacies (aRR 1.83, 95% CI [1.37-2.44]) and prescribe self-administered DMPA-SQ (aRR 3.85, 95% CI [2.40-6.18]). Clinics closed on-site were just as likely to use telemedicine as those that remained open. Among clinics using telemedicine, those closed on-site continued facing challenges in contraceptive service provision.
Clinics closing on-site were just as likely to offer telemedicine, but faced greater challenges in offering contraceptive counseling and the full range of contraceptive methods, and meeting the needs of marginalized communities. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic.
在 COVID-19 大流行期间，提供者在维持患者获得避孕服务和公共卫生安全方面面临挑战。由于获得护理的障碍增加，提供者越来越多地将远程医疗用于避孕护理、路边服务、邮购药房以及在线或家庭配送避孕方法，包括自行皮下注射醋酸甲羟孕酮（DMPA-SQ）。为了更好地了解生殖健康提供者在大流行期间如何调整服务提供，本研究评估了临床实践的变化以及美国各地提供者为维持避孕护理而采用的策略，特别是当诊所现场关闭时，以及在提供避孕服务方面仍然存在的挑战，特别是对边缘化患者群体。
我们于 2020 年 4 月至 2021 年 1 月期间调查了美国的提供者和诊所工作人员（n=907），收集了关于避孕服务提供挑战和适应措施的信息，包括远程医疗。我们使用广义线性模型中的多元回归分析评估了临床实践的变化，该模型采用泊松分布和集群稳健标准误差，调整了诊所患者量、实践设置、区域、Title X 资金和调查时间。
尽管 80%的提供者报告他们的诊所仍在开放，但仍有 20%的诊所现场关闭。提供者表示，大流行使得提供全面的避孕方法（65%）、避孕咨询（61%）或满足边缘化社区患者的需求（50%）更加困难。尽管只有 11%的提供者在大流行前提供远程医疗，但大多数在大流行期间提供远程医疗访问（79%）。一些人使用邮购药房（35%）、路边避孕服务（22%）和自行管理的 DMPA-SQ（10%）。现场关闭的诊所更有可能使用邮购药房（ARR 1.83，95%CI [1.37-2.44]）和开出自行管理的 DMPA-SQ（ARR 3.85，95%CI [2.40-6.18]）。现场关闭的诊所与开放的诊所一样有可能使用远程医疗。在使用远程医疗的诊所中，现场关闭的诊所继续面临避孕服务提供方面的挑战。
现场关闭的诊所同样有可能提供远程医疗，但在提供避孕咨询和全面的避孕方法以及满足边缘化社区的需求方面面临更大的挑战。在大流行期间和之后，维持避孕服务的面对面护理是一个重要目标，尽管存在人员配备短缺和财务困难。
