OHSU-PSU School of Public Health, Health Systems & Policy, Portland, Oregon, USA
Ibis Reproductive Health, Oakland, California, USA.
BMJ Sex Reprod Health. 2024 Jan 9;50(1):33-42. doi: 10.1136/bmjsrh-2023-201931.
We used the newly developed Abortion Care Quality Tool (ACQTool) to compare client-reported quality of medication abortion care by source (facility-managed vs pharmacy-sourced self-managed abortion (SMA)) in Bangladesh.
We leveraged exit and 30-day follow-up surveys collected to develop and validate the ACQTool collected at nongovernmental organisation (NGO)-supported or -operated facilities in the public and private sector and pharmacies from three districts in Bangladesh. We used bivariate statistics to compare 18 client-reported quality indicators grouped in six domains and eight abortion outcomes, by source (facility vs pharmacy). We used multivariable logistic regression to identify factors associated with selected quality indicators and outcomes (abortion affordability, information provision, and knowing what to do for an adverse event), controlling for client sociodemographic characteristics.
Of 550 abortion clients, 146 (26.5%) received a facility-managed medication abortion and 404 (73.5%) had a pharmacy-sourced SMA. Clients reported higher quality in facilities for five indicators, and higher in pharmacies for two indicators; the remaining 11 indicators were not different by source. Compared with facility-based clients, pharmacy clients had higher odds of reporting that the cost of abortion was affordable (adjusted odds ratio (aOR) 3.55; 95% CI 2.27 to 5.58) but lower odds of reporting high information provision (aOR 0.14; 95% CI 0.09 to 0.23). Seven of eight abortion outcomes showed no differences; pharmacy clients had lower odds of knowing what to do if an adverse event occurred (aOR 0.45; 95% CI 0.23 to 0.82).
In Bangladesh, there is no difference in client-reported quality of medication abortion care between health facilities and pharmacies for the majority of quality and outcome indicators. However, information provision and preparedness were higher quality at facilities, while pharmacies were more affordable.
我们使用新开发的流产护理质量工具（ACQTool）比较了孟加拉国通过来源（医疗机构管理与药房来源的自我管理流产（SMA））报告的药物流产护理质量。
我们利用在孟加拉国三个地区的非政府组织（NGO）支持或运营的设施和药房收集的退出和 30 天随访调查来开发和验证 ACQTool。我们使用双变量统计比较了 18 项客户报告的质量指标，这些指标分为六个领域和八个流产结果，按来源（设施与药房）进行分组。我们使用多变量逻辑回归来确定与选定的质量指标和结果（流产负担能力、信息提供和对不良事件的应对措施）相关的因素，同时控制了客户的社会人口统计学特征。
在 550 名流产客户中，有 146 名（26.5%）接受了医疗机构管理的药物流产，404 名（73.5%）进行了药房来源的 SMA。客户在设施方面报告了五个指标的更高质量，在药房方面报告了两个指标的更高质量；其余 11 个指标的来源没有差异。与基于设施的客户相比，药房客户报告流产费用负担得起的可能性更高（调整后的优势比（aOR）为 3.55；95%CI 2.27 至 5.58），但报告高信息提供的可能性更低（aOR 0.14；95%CI 0.09 至 0.23）。八个流产结果中有七个没有差异；药房客户如果发生不良事件，知道该做什么的可能性较低（aOR 0.45；95%CI 0.23 至 0.82）。
在孟加拉国，对于大多数质量和结果指标，客户报告的药物流产护理质量在医疗机构和药房之间没有差异。然而，信息提供和准备在设施方面质量更高，而药房则更具负担能力。
