Person-centered, high-quality care from a distance: A qualitative study of patient experiences of TelAbortion, a model for direct-to-patient medication abortion by mail in the United States.

IF 3.4 2区 医学 Q1 DEMOGRAPHY Perspectives on Sexual and Reproductive Health Pub Date : 2022-12-01 DOI:10.1363/psrh.12210
Courtney Kerestes, Rebecca Delafield, Jennifer Elia, Tara Shochet, Bliss Kaneshiro, Reni Soon
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引用次数: 1

Abstract

Context: Direct-to-patient telemedicine abortion allows people to receive mifepristone and misoprostol for medication abortion in their home without requiring an in-person visit with a healthcare provider. This method has high efficacy and safety, but less is known about the person-centered quality of care provided with telemedicine.

Methods: We interviewed 45 participants from the TelAbortion study of direct-to-patient telemedicine abortion in the United States from January to July 2020. Semi-structured qualitative interviews queried their choices, barriers to care, expectations for care, actual abortion experience, and suggestions for improvement. We developed a codebook through an iterative, inductive process and performed content and thematic analyses.

Results: The experience of direct-to-patient telemedicine abortion met the person-centered domains of dignity, autonomy, privacy, communication, social support, supportive care, trust, and environment. Four themes relate to the person-centered framework for reproductive health equity: (1) Participants felt well-supported and safe with TelAbortion; (2) Participants had autonomy in their care which led to feelings of empowerment; (3) TelAbortion exceeded expectations; and (4) Challenges arose when interfacing with the healthcare system outside of TelAbortion. Participants perceived abortion stigma which often led them to avoid traditional care and experienced enacted stigma during encounters with non-study healthcare workers.

Conclusion: TelAbortion is a high quality, person-centered care model that can empower patients seeking care in an increasingly challenging abortion context.

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以人为本,高质量的远程护理:美国通过邮件直接对患者进行药物流产的一种模式——远程流产患者体验的定性研究。
背景:直接面向患者的远程医疗流产允许人们在家中接受米非司酮和米索前列醇治疗药物流产,而无需亲自前往医疗保健提供者。这种方法具有很高的有效性和安全性,但对远程医疗提供的以人为本的护理质量知之甚少。方法:我们对2020年1月至7月在美国进行的直接对患者远程医疗流产的远程流产研究的45名参与者进行了访谈。半结构化的定性访谈询问了她们的选择、护理的障碍、对护理的期望、实际堕胎经历和改进建议。我们通过迭代、归纳的过程开发了一个密码本,并进行了内容和主题分析。结果:直接面向患者的远程医疗流产体验满足以人为本的尊严、自主、隐私、沟通、社会支持、支持性护理、信任和环境等领域。四个主题涉及以人为本的生殖健康公平框架:(1)参与者感到远程堕胎得到了良好的支持和安全;(2)参与者在照顾过程中具有自主性,从而产生赋权感;(3)远程流产超出预期;(4)与TelAbortion以外的医疗保健系统对接时出现的挑战。参与者认为堕胎耻辱,这往往导致他们避免传统护理和经历制定耻辱与非研究卫生保健工作者的接触。结论:远程流产是一种高质量的、以人为本的护理模式,可以使患者在日益具有挑战性的流产环境中寻求护理。
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来源期刊
CiteScore
5.10
自引率
3.40%
发文量
24
期刊介绍: Perspectives on Sexual and Reproductive Health provides the latest peer-reviewed, policy-relevant research and analysis on sexual and reproductive health and rights in the United States and other developed countries. For more than four decades, Perspectives has offered unique insights into how reproductive health issues relate to one another; how they are affected by policies and programs; and their implications for individuals and societies. Published four times a year, Perspectives on Sexual and Reproductive Health includes original research, special reports and commentaries on the latest developments in the field of sexual and reproductive health, as well as staff-written summaries of recent findings in the field.
期刊最新文献
Understanding abortion legality and trimester of abortion care in Ohio, West Virginia and Kentucky, three abortion‐restrictive states Exploring adolescent-facing US clinicians' perceptions of their contraceptive counseling and use of shared decision-making: A qualitative study. "It shouldn't be just hush-hush": A qualitative community-based study of menstrual health communication among women in Philadelphia. Amicus brief of over 300 reproductive health researchers supports mifepristone's safety and effectiveness. Brief of over 300 reproductive health researchers as Amici Curiae in FDA v. Alliance for Hippocratic Medicine.
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