邮寄堕胎药并不会延迟护理：美国一项比较邮寄和面对面分发堕胎药物的队列研究。
Mailing abortion pills does not delay care: A cohort study comparing mailed to in-person dispensing of abortion medications in the United States.
机构信息
Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, Oakland, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Center for Gender and Health Justice, University of California Global Health Institute.
Gynuity Health Projects, New York, NY, USA.
出版信息
Contraception. 2023 May;121:109962. doi: 10.1016/j.contraception.2023.109962. Epub 2023 Feb 2.
OBJECTIVE
Given the substantial barriers to abortion access in the United States, many clinics now mail patients abortion medications. We examined whether dispensing the medications by mail prolonged time to medication use.
STUDY DESIGN
We analyzed data from no-test medication abortions with medication provided either by mail or in a clinic from 11 United States clinics from February 2020 to January 2021. We examined mean number of days from patients' first contact with the clinic to mifepristone ingestion, its two-component intervals (first contact to medication dispensing and dispensing to mifepristone ingestion), and pregnancy duration at mifepristone ingestion. We used Poisson regression to compare mean outcomes across three dispensing methods: in-person, mailed from the clinic, and mailed from a mail-order pharmacy.
RESULTS
Among the 2600 records, patients took mifepristone on average at 49 days of gestation (95% CI, 47-51) and 7 days (95% CI, 4-10) after first contact. Mean time from first contact to mifepristone ingestion was 6 days when medications were dispensed in-person and 9 days when mailed (p = 0.38). While time from first contact to dispensing was similar across methods (6 days in-person, 5 days mailed, p = 0.77), more time elapsed from dispensing to mifepristone ingestion when medications were mailed (4 days from clinic, 5 days from mail-order pharmacy) versus dispensed in-person (0.3 days, p < 0.001). Time to mifepristone ingestion was shorter with higher pregnancy duration. Pregnancy duration at ingestion was similar across methods (48 days in-person, 50 days mailed).
CONCLUSIONS
Mailing medications did not significantly prolong time from patients' first contact with the clinic to mifepristone ingestion or increase pregnancy duration at mifepristone ingestion.
IMPLICATIONS
Abortion providers should offer a range of medication abortion dispensing options, prioritizing patient preference.
目的
鉴于美国堕胎准入存在巨大障碍，许多诊所现在通过邮寄向患者提供堕胎药物。我们研究了通过邮寄方式提供药物是否会延长用药时间。
研究设计
我们分析了 2020 年 2 月至 2021 年 1 月期间，来自美国 11 家诊所的 2600 例无检测药物流产数据，这些药物流产的药物通过邮寄或在诊所提供。我们研究了患者首次联系诊所至米非司酮服用的平均天数、其两个组成部分的间隔（首次联系至药物发放和发放至米非司酮服用）以及米非司酮服用时的妊娠持续时间。我们使用泊松回归比较了三种发放方法（门诊、诊所邮寄和邮购药房邮寄）的平均结果。
结果
在 2600 例记录中，患者平均在妊娠 49 天（95%CI，47-51）时服用米非司酮，在首次联系后 7 天（95%CI，4-10）服用米非司酮。当药物在门诊发放时，从首次联系到米非司酮服用的平均时间为 6 天，当药物邮寄时为 9 天（p=0.38）。虽然不同方法之间首次联系到发放的时间相似（门诊 6 天，邮寄 5 天，p=0.77），但药物邮寄时从发放到米非司酮服用的时间间隔更长（诊所 4 天，邮购药房 5 天），而不是门诊发放（0.3 天，p<0.001）。米非司酮服用时间随妊娠持续时间缩短而缩短。不同方法之间的米非司酮服用时的妊娠持续时间相似（门诊 48 天，邮寄 50 天）。
结论
邮寄药物并未显著延长患者首次联系诊所到米非司酮服用的时间，也不会增加米非司酮服用时的妊娠持续时间。
启示
堕胎提供者应提供一系列药物流产发放选择，优先考虑患者的偏好。
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