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“我们只需要尽可能多地创造获取途径”:美国南部临床医生和管理人员对远程医疗药物流产的态度。

"We just need to create as many avenues for access as we possibly can": Clinician and administrator attitudes toward telehealth medication abortion in the U.S. South.

作者信息

Bhandari Parie, Narasimhan Subasri, Newton-Levinson Anna

机构信息

Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States.

Center for Reproductive Health Research in the Southeast, Emory University, Atlanta, GA, United States.

出版信息

Contracept X. 2024 Oct 9;6:100112. doi: 10.1016/j.conx.2024.100112. eCollection 2024.

Abstract

OBJECTIVES

There is currently a gap in literature on the perspectives of sexual and reproductive health providers in the South toward telehealth abortion services. This research seeks to explore these perspectives to understand provider attitudes toward importance and priority of telehealth abortion to contribute to the development of a richer understanding of this in the South.

STUDY DESIGN

This study conducts a secondary analysis of data from the Provider Readiness for Virtual Implementation and Delivery of Medication Abortion Services (PROVIDA) study. We collected qualitative data regarding perspectives of 20 providers toward importance and priority of telehealth abortion during a series of in-depth interviews that took place from June 2021-2022.

RESULTS

We identified four main themes: telehealth abortion is important for patient benefit in mitigating physical, administrative, financial, and privacy-related barriers; telehealth abortion is important for clinic benefit in improving clinic flow and sustainability; the political climate affects personal prioritization of telehealth abortion; and staff hesitance affects clinic prioritization of telehealth abortion.

CONCLUSIONS

Our analysis revealed telehealth abortion to be particularly important in mitigating physical barriers for patients and for clinic sustainability. We found the political climate to be the most notable factor influencing personal prioritization of telehealth abortion, with most participants noting it made telehealth abortion less of a priority. Additionally, our analysis found participant perception of staff hesitation to implement telehealth abortion to be the most notable factor affecting clinic prioritization. Future research should utilize these findings to inform studies examining the implementation climate of telehealth abortion in the South.

IMPLICATIONS

Highlighting insights from SRH professionals in restrictive environments, this study emphasizes the potential of telehealth abortion to mitigate the unique barriers to access and provision that abortion seekers and providers face in the U.S. South. This has important implications for motivating implementation in states where abortion is still legal but telehealth abortion is prohibited.

摘要

目的

目前关于南方性与生殖健康服务提供者对远程医疗堕胎服务看法的文献存在空白。本研究旨在探索这些看法,以了解提供者对远程医疗堕胎重要性和优先级的态度,从而更深入地理解南方的这一情况。

研究设计

本研究对药物流产服务虚拟实施与交付的提供者准备情况(PROVIDA)研究的数据进行二次分析。我们在2021年6月至2022年期间进行的一系列深入访谈中,收集了20名提供者对远程医疗堕胎重要性和优先级的定性数据。

结果

我们确定了四个主要主题:远程医疗堕胎对患者有益,可减轻身体、行政、财务和隐私相关障碍;远程医疗堕胎对诊所有益,可改善诊所流程和可持续性;政治气候影响个人对远程医疗堕胎的优先级排序;工作人员的犹豫影响诊所对远程医疗堕胎的优先级排序。

结论

我们的分析表明,远程医疗堕胎在减轻患者身体障碍和诊所可持续性方面尤为重要。我们发现政治气候是影响个人对远程医疗堕胎优先级排序的最显著因素,大多数参与者指出这使得远程医疗堕胎的优先级降低。此外,我们的分析发现参与者认为工作人员对实施远程医疗堕胎的犹豫是影响诊所优先级排序的最显著因素。未来的研究应利用这些发现,为研究南方远程医疗堕胎的实施环境提供参考。

启示

本研究突出了在限制环境下性与生殖健康专业人员的见解,强调了远程医疗堕胎在减轻美国南方堕胎寻求者和提供者面临的独特获取和提供障碍方面的潜力。这对于推动在堕胎仍合法但禁止远程医疗堕胎的州实施该服务具有重要意义。

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本文引用的文献

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Effectiveness and safety of telehealth medication abortion in the USA.美国远程医疗药物流产的有效性和安全性。
Nat Med. 2024 Apr;30(4):1191-1198. doi: 10.1038/s41591-024-02834-w. Epub 2024 Feb 15.
4
Telemedicine Provision of Medication Abortion.远程医疗提供药物流产服务。
Am J Public Health. 2022 Sep;112(9):1282-1283. doi: 10.2105/AJPH.2022.306995. Epub 2022 Jul 21.
5
Telemedicine, Medication Abortion, and Access After .远程医疗、药物流产与之后的可及性
Am J Public Health. 2022 Aug;112(8):1086-1088. doi: 10.2105/AJPH.2022.306948.
6
Supporting Staff in Southern Family Planning Clinics: Challenges and Opportunities.南方计划生育诊所的辅助人员:挑战与机遇。
Matern Child Health J. 2022 Feb;26(2):319-327. doi: 10.1007/s10995-021-03339-5. Epub 2022 Jan 8.
8
State Abortion Policies and Maternal Death in the United States, 2015‒2018.2015 - 2018年美国各州堕胎政策与孕产妇死亡情况
Am J Public Health. 2021 Sep;111(9):1696-1704. doi: 10.2105/AJPH.2021.306396. Epub 2021 Aug 19.

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