Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States.
Obstetrics and Gynecology - Complex Family Planning Division, University of California, Los Angeles, CA, United States.
Contraception. 2023 Jan;117:50-54. doi: 10.1016/j.contraception.2022.08.003. Epub 2022 Aug 30.
Although California is a state with supportive abortion policies, recent evidence suggests people may still encounter barriers to obtaining timely abortion care. To provide an in-depth understanding of these barriers and augment existing literature focusing on restrictive and hostile states, we sought to understand the patient perspectives of barriers to timely abortion care in Los Angeles, California.
We recruited participants from two, high-volume urban clinical sites and conducted semi-structured interviews with 17 individuals who visited three or more clinics and/or encountered more than 2 weeks between seeking and obtaining their abortion. Using thematic analysis, we analyzed deidentified transcripts by first developing and applying codes, then identifying overarching themes to describe barriers to timely abortion care.
Participants described three primary barriers leading to abortion care delay: (1) difficulties in ensuring insurance coverage or securing authorization for abortion care from private/employer-sponsored insurance, (2) inadequate screening resulting in multiple appointments where desired care could not be provided, and (3) difficulties with expeditious referrals to appropriate clinical sites. Participants also described accumulated fatigue from facing layers of resistance when pursuing avenues for care.
Even in supportive abortion policy states, barriers to abortion care from insurance, screening, and referral-related issues may result in delayed or unaccessed care, negatively impacting patient experience. Understanding and mitigating reasons for delays are critical to improving patient experience with abortion care.
Standardized telephone triage at local clinic facilities and streamlined MediCal authorization of abortion services may mitigate barriers to timely abortion care.
尽管加利福尼亚州的堕胎政策较为支持，但最近的证据表明，人们在获得及时堕胎护理方面可能仍会遇到障碍。为了深入了解这些障碍，并补充现有专注于限制和敌对州的文献，我们试图了解加利福尼亚州洛杉矶患者在及时堕胎护理方面遇到的障碍。
我们从两个高流量的城市临床站点招募了参与者，并对 17 名个体进行了半结构化访谈，这些个体访问了三个或更多的诊所，并且/或者在寻求和获得堕胎之间的时间超过了 2 周。通过主题分析，我们首先开发并应用了代码，然后确定了总体主题，以描述及时堕胎护理的障碍，对去识别的转录本进行了分析。
参与者描述了导致堕胎护理延迟的三个主要障碍：（1）确保私人/雇主赞助的保险涵盖堕胎护理或获得堕胎护理授权的困难，（2）筛选不足导致多次预约，无法提供所需的护理，（3）快速转介到合适的临床站点的困难。参与者还描述了在寻求护理途径时面临层层阻力所带来的累积疲劳。
即使在支持堕胎政策的州，与保险、筛选和转介相关的问题也可能导致堕胎护理延迟或无法获得，从而对患者体验产生负面影响。了解和减轻延迟的原因对于改善堕胎护理的患者体验至关重要。
在当地诊所设施进行标准化电话分诊和简化 MediCal 对堕胎服务的授权可能会减轻及时堕胎护理的障碍。
