Department of Family Medicine, University of Washington, Seattle, Washington
Department of Family Medicine, University of Washington, Seattle, Washington.
Ann Fam Med. 2022 Jul-Aug;20(4):336-342. doi: 10.1370/afm.2821. Epub 2022 Jul 13.
Established models of reproductive health service delivery were disrupted by the coronavirus disease 2019 (COVID-19) pandemic. This study examines rapid innovation of remote abortion service operations across health care settings and describes the use of telehealth consultations with medications delivered directly to patients.
We conducted semi-structured interviews with 21 clinical staff from 4 practice settings: family planning clinics, online medical services, and primary care practices-independent or within multispecialty health systems. Clinicians and administrators described their telehealth abortion services. Interviews were recorded, transcribed, and analyzed. Staff roles, policies, and procedures were compared across practice settings.
Across all practice settings, telehealth abortion services consisted of 5 operational steps: patient engagement, care consultations, payment, medication dispensing, and follow-up communication. Online services and independent primary care practices used asynchronous methods to determine eligibility and complete consultations, resulting in more efficient services (2-5 minutes), while family planning and health system clinics used synchronous video encounters requiring 10-30 minutes of clinician time. Family planning and health system primary care clinics mailed medications from clinic stock or internal pharmacies, while independent primary care practices and online services often used mail-order pharmacies. Online services offered patients asynchronous follow-up; other practice settings scheduled synchronous appointments.
Rapid innovations implemented in response to disrupted in-person reproductive health care included remote medication abortion services with telehealth assessment/follow-up and mailed medications. Though consistent operational steps were identified across health care settings, variation allowed for adaptation of services to individual sites. Understanding remote abortion service operations may facilitate dissemination of a range of patient-centered reproductive health services. article.
新冠疫情（COVID-19）大流行打乱了生殖健康服务的既定模式。本研究考察了医疗保健环境中远程堕胎服务运营的快速创新，并描述了使用远程医疗咨询和直接向患者提供药物的情况。
我们对来自 4 个实践环境（计划生育诊所、在线医疗服务和初级保健实践——独立或在多专业保健系统内）的 21 名临床工作人员进行了半结构式访谈。临床医生和管理人员描述了他们的远程堕胎服务。对访谈进行了录音、转录和分析。比较了不同实践环境中的工作人员角色、政策和程序。
在所有实践环境中，远程堕胎服务都包括 5 个操作步骤：患者参与、护理咨询、支付、药物配药和随访沟通。在线服务和独立的初级保健实践使用异步方法来确定资格并完成咨询，从而提供更高效的服务（2-5 分钟），而计划生育和保健系统诊所则使用同步视频会议，需要 10-30 分钟的临床医生时间。计划生育和保健系统的初级保健诊所从诊所库存或内部药房邮寄药物，而独立的初级保健实践和在线服务通常使用邮购药房。在线服务为患者提供异步随访；其他实践环境则安排同步预约。
针对面对面生殖保健服务中断而实施的快速创新包括远程药物流产服务，采用远程医疗评估/随访和邮寄药物。尽管在不同的医疗保健环境中确定了一致的操作步骤，但变化允许根据各个站点的情况调整服务。了解远程堕胎服务运营情况可能有助于推广一系列以患者为中心的生殖健康服务。
