Changes in Service Delivery Patterns After Introduction of Telemedicine Provision of Medical Abortion in Iowa
Changes in Service Delivery Patterns After Introduction of Telemedicine Provision of Medical Abortion in Iowa
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DOI：
10.2105/ajph.2012.301097
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发表时间：
2013-01-01
影响因子：
12.7
通讯作者：
Schmertmann, Carl P.
中科院分区：
文献类型：
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作者：
Grossman, Daniel A.;Grindlay, Kate;Schmertmann, Carl P.
目标.我们评估了在爱荷华州的一个诊所系统中提供药物流产服务的远程医疗模式的效果。我们回顾了爱荷华州的重要统计数据和计费数据，从诊所系统的所有堕胎的遭遇，在2008年6月推出telennedicine之前和之后的2年（n = 17956遭遇）。我们计算了从患者的住宅邮政编码到诊所以及到最近的提供手术流产的诊所的距离。在引入远程医疗后，爱荷华州的堕胎率下降了，医疗诊所的堕胎比例从46%上升到54%。在引入远程医疗后，并对其他因素进行调整，诊所患者在妊娠13周前获得药物流产和流产的几率增加了。虽然前往诊所的距离仅略有减少，但居住在距离最近的提供手术流产的诊所超过50英里的妇女在远程医疗引入后更有可能获得流产。远程医疗可以改善医疗堕胎的获得，特别是对生活在偏远地区的妇女而言，并减少中期妊娠堕胎。(Am J公共卫生。2013;103：73-78. doi：10.2105/AJPH.2012.301097）
Objectives. We assessed the effect of a telemedicine model providing medical abortion on service delivery in a clinic system in Iowa.Methods. We reviewed Iowa vital statistic data and billing data from the clinic system for all abortion encounters during the 2 years prior to and after the introduction of telennedicine in June 2008 (n = 17956 encounters). We calculated the distance from the patient's residential zip code to the clinic and to the closest clinic providing surgical abortion.Results. The abortion rate decreased in Iowa after telemedicine introduction, and the proportion of abortions in the clinics that were medical increased from 46% to 54%. After telemedicine was introduced, and with adjustment for other factors, clinic patients had increased odds of obtaining both medical abortion and abortion before 13 weeks' gestation. Although distance traveled to the clinic decreased only slightly, women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction.Conclusions. Telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion. (Am J Public Health. 2013;103:73-78. doi:10.2105/AJPH.2012.301097)