Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States.
Assessing differences in contraceptive provision through telemedicine among reproductive health providers during the COVID-19 pandemic in the United States.
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DOI：
10.1186/s12978-022-01388-9
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发表时间：
2022-04-22
影响因子：
3.4
通讯作者：
Harper, Cynthia C.
中科院分区：
文献类型：
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作者：
Comfort, Alison B.;Rao, Lavanya;Goodman, Suzan;Raine-Bennett, Tina;Barney, Angela;Mengesha, Biftu;Harper, Cynthia C.
在2019冠状病毒病大流行期间，供应商在确保患者获得避孕服务和公共卫生安全方面面临挑战。由于护理障碍增加，提供者越来越多地使用远程医疗进行避孕护理、路边服务、邮购药房以及在线或家庭提供避孕方法，包括自行皮下注射醋酸甲羟孕酮（DMPA-SQ）。为了更好地了解生殖健康提供者在大流行期间如何调整服务提供，本研究评估了美国各地提供者为维持避孕护理而采取的临床实践变化和策略，特别是在诊所关闭时，以及在提供避孕服务方面仍然存在的挑战，特别是向边缘化患者群体提供避孕服务。我们于2020年4月至2021年1月对美国提供者和诊所工作人员（n = 907）进行了调查，收集了有关避孕服务提供挑战和适应的数据，包括远程医疗。我们使用具有泊松分布和聚类稳健标准误差的广义线性模型进行多元回归分析，评估临床实践的变化，调整临床患者数量、实践环境、地区、标题X资助和调查时间。虽然80%的提供者报告他们的诊所仍然开放，但20%的诊所已经关闭。服务提供者说，大流行加大了提供全套避孕方法（65%）、避孕咨询（61%）或满足边缘化社区患者需求（50%）的难度。虽然只有11%的提供者在大流行前提供远程医疗，但在大流行期间，大多数提供者提供远程医疗出诊（79%）。一些人使用邮购药房（35%）、路边避孕服务（22%）和自行给药（10%）。现场关闭的诊所更有可能使用邮购药房（aRR 1.83, 95% CI[1.37-2.44]）和自用DMPA-SQ （aRR 3.85, 95% CI[2.40-6.18]）。现场关闭的诊所与那些仍然开放的诊所一样可能使用远程医疗。在使用远程医疗的诊所中，就地关闭的诊所在提供避孕服务方面继续面临挑战。现场关闭的诊所同样有可能提供远程医疗，但在提供避孕咨询和各种避孕方法以及满足边缘化社区的需求方面面临更大的挑战。在人员短缺和财政困难的情况下，维持避孕服务的面对面护理是大流行病期间和之后的一个重要目标。在2019冠状病毒病大流行期间，供应商在确保患者获得避孕服务和公共卫生安全方面面临挑战。由于护理障碍增加，提供者越来越多地使用远程医疗进行避孕护理，以及使用路边服务、邮购药房和在线或家庭提供避孕方法，包括自行皮下注射醋酸甲羟孕酮（DMPA-SQ）。本研究调查了2019冠状病毒病大流行期间美国避孕服务提供者使用远程医疗和其他临床实践的变化。我们在2020年4月至2021年1月期间对服务提供者（n=907）进行了调查，收集了有关避孕服务提供挑战和适应的数据，包括远程医疗。我们的分析表明，为应对大流行，许多诊所采用远程医疗提供避孕服务。此外，在大流行期间，现场关闭的诊所与仍然开放的诊所一样有可能开始提供远程医疗就诊。尽管进行了这些调整，但诊所在提供全面的避孕方法、提供避孕咨询和满足边缘化社区患者的需求方面仍然面临挑战。在大流行期间提供远程医疗访问并没有减少提供避孕服务方面的挑战。很少有研究关注提供者及其在大流行期间为保持患者获得避孕药具而迅速实现的临床实践变化。我们的研究结果强调，远程医疗应被视为现场护理的补充，因为在没有亲自就诊的情况下提供全面服务存在挑战。在人员短缺和财政困难的情况下，维持避孕服务的面对面护理是大流行病期间和之后的一个重要目标。
Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care, curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). To better understand how reproductive health providers adapted service provision during the pandemic, this study assessed clinical practice changes and strategies providers adopted throughout the United States to maintain contraceptive care, particularly when clinics closed on-site, and the challenges that remained in offering contraceptive services, especially to marginalized patient populations. We surveyed U.S. providers and clinic staff (n = 907) in April 2020–January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. We assessed clinical practice changes with multivariate regression analyses using generalized linear models with a Poisson distribution and cluster robust standard errors, adjusting for clinic patient volume, practice setting, region, Title X funding, and time of survey. While 80% of providers reported their clinic remained open, 20% were closed on-site. Providers said the pandemic made it more difficult to offer the full range of contraceptive methods (65%), contraceptive counseling (61%) or to meet the needs of patients in marginalized communities (50%). While only 11% of providers offered telemedicine pre-pandemic, most offered telemedicine visits (79%) during the pandemic. Some used mail-order pharmacies (35%), curbside contraceptive services (22%), and DMPA-SQ for self-administration (10%). Clinics that closed on-site were more likely to use mail-order pharmacies (aRR 1.83, 95% CI [1.37–2.44]) and prescribe self-administered DMPA-SQ (aRR 3.85, 95% CI [2.40–6.18]). Clinics closed on-site were just as likely to use telemedicine as those that remained open. Among clinics using telemedicine, those closed on-site continued facing challenges in contraceptive service provision. Clinics closing on-site were just as likely to offer telemedicine, but faced greater challenges in offering contraceptive counseling and the full range of contraceptive methods, and meeting the needs of marginalized communities. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic. Providers faced challenges in maintaining patient access to contraceptive services and public health safety during the COVID-19 pandemic. Due to increased barriers to care, providers increasingly used telemedicine for contraceptive care as well as using curbside services, mail-order pharmacies, and on-line or home delivery of contraceptive methods, including self-administration of subcutaneous depo medroxyprogesterone acetate (DMPA-SQ). This study examined use of telemedicine and other clinical practice changes among U.S. contraceptive providers during the COVID-19 pandemic. We surveyed providers (n=907) in April 2020–January 2021, collecting data on contraceptive service delivery challenges and adaptations, including telemedicine. Our analyses showed that, in response to the pandemic, many clinics adopted telemedicine to offer contraceptive services. Furthermore, clinics that were closed on-site were just as likely to start offering telemedicine visits during the pandemic as those that remained open. Despite these adaptions, clinics still faced challenges in offering the full range of contraceptive methods, providing contraceptive counseling, and meeting the needs of patients in marginalized communities. Offering telemedicine visits during the pandemic did not reduce the challenges in offering contraceptive services. Few studies have focused on providers and the clinical practice changes they rapidly achieved to maintain contraceptive access for their patients during the pandemic. Our results highlighted that telemedicine should be considered as a complement to on-site care because of the challenges in providing full services without in-person visits. Maintaining in-person care for contraceptive services, in spite of staffing shortages and financial difficulties, is an important objective during and beyond the pandemic.
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