Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US.
Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US.
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DOI：
10.1001/jamanetworkopen.2021.11852
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发表时间：
2021-05-03
影响因子：
13.8
通讯作者：
Gomperts R
中科院分区：
文献类型：
--
作者：
Aiken ARA;Starling JE;Gomperts R
这项横断面研究评估了美国个人通过在线远程医疗服务获得自我管理的药物流产的原因以及与这些请求相关的因素。在美国，使用在线远程医疗服务获取自我管理的药物流产有哪些相关因素？在这项对2,458个县的57名 506人进行的横断面研究中，门诊护理费用是使用在线远程医疗进行自我管理堕胎的最常被引用的原因。在县一级，距离最近的诊所距离增加47英里与请求增加41%显著相关，生活在联邦贫困水平以下的人口增加10%与请求增加20%显著相关。在这项研究中，诊所准入障碍是获得自我管理药物流产的最常见原因，距离堕胎诊所的距离和生活在联邦贫困水平以下都与对自我管理的更高需求有关。在美国，人们一直在寻求通过在线远程医疗获得药物，在正规医疗系统之外进行自我管理的堕胎。然而，人们对这种做法知之甚少，包括潜在的动机因素。审查通过在线远程医疗服务获得药物堕胎的个人原因，以及州和县两级因素与请求率之间的关系。这项基于人群的横断面研究调查了2018年3月20日至2020年3月20日期间，通过美国远程医疗服务Aid Access提供的在线咨询表格提出的所有自我管理药物堕胎的请求。审查了获得远程医疗服务的个人原因以及各州每10万 ，000名育龄妇女提出要求的比率。提出请求的个人提供的邮政编码数据被用来检查假设与自我管理堕胎需求增加有关的县级因素：到诊所的距离(使用美国堕胎诊所的位置数据计算)，以及确定为种族/少数民族群体成员、生活在联邦贫困水平以下以及拥有宽带互联网接入的人口比例(使用人口普查数据计算)。在为期两年的研究期间，50个州的2458个县的57名 506人要求自我管理药物流产；52.1%的人年龄在20至29岁(平均年龄25.9[6.7]岁)，50.0%的人有孩子，99.9%的人怀孕10周或更短。提出请求的个人最常见的原因是负担不起门诊护理(73.5%)、隐私(49.3%)和诊所距离(40.4%)。请求率最高的州是路易斯安那州(每10万 000名妇女中有202.7名)和密西西比州(每100名 000名妇女中有199.9名)。在县一级，距离最近的诊所每增加1 SD(47英里)，请求增加41%(发病率比1.41；95%CI，1.31-1.51；P <； .001)；生活在联邦贫困水平以下的人口每增加10%，请求增加20%(发病率比1.20；95%CI，1.13-1.28；P <； .001)。在这项横断面研究中，诊所准入障碍是要求使用在线远程医疗服务进行自我管理药物流产的最常见原因。在县一级，距离堕胎诊所的距离和生活在联邦贫困线以下与较高的请求率相关。州和联邦立法可以解决这些准入障碍。
This cross-sectional study assesses the reasons that individuals in the US are accessing self-managed medication abortion through online telemedicine services and the factors associated with these requests. What factors are associated with use of an online telemedicine service for accessing self-managed medication abortion in the US? In this cross-sectional study of 57 506 individuals in 2458 counties, the cost of in-clinic care was the most commonly cited reason for accessing self-managed abortion using online telemedicine. At the county level, a 47-mile increase in distance to the nearest clinic was significantly associated with a 41% increase in requests, and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests. In this study, clinic access barriers were the most common reason for accessing self-managed medication abortion, and both distance to an abortion clinic and living below the federal poverty level were associated with higher demand for self-management. People in the US have been seeking self-managed abortions outside the formal health care system using medications obtained through online telemedicine. However, little is known about this practice, including potential motivating factors. To examine individual reasons for accessing medication abortion through an online telemedicine service as well as associations between state- and county-level factors and the rate of requests. This population-based cross-sectional study examined all requests for self-managed medication abortion through an online consultation form available from Aid Access, a telemedicine service in the US, between March 20, 2018, and March 20, 2020. Individual-level reasons for accessing the telemedicine service were examined as well as the rate of requests per 100 000 women of reproductive age by state. Zip code data provided by individuals making requests were used to examine county-level factors hypothesized to be associated with increased demand for self-managed abortion: distance to a clinic (calculated using location data for US abortion clinics) and the population proportion identifying as a member of a racial/ethnic minority group, living below the federal poverty level, and having broadband internet access (calculated using census data). During the 2-year study period, 57 506 individuals in 2458 counties in 50 states requested self-managed medication abortion; 52.1% were aged 20 to 29 years (mean [SD] age, 25.9 [6.7] years), 50.0% had children, and 99.9% were 10 weeks’ pregnant or less. The most common reasons cited by individuals making requests were the inability to afford in-clinic care (73.5%), privacy (49.3%), and clinic distance (40.4%). States with the highest rate of requests were Louisiana (202.7 per 100 000 women) and Mississippi (199.9 per 100 000 women). At the county level, an increase of 1 SD (47 miles) in distance to the nearest clinic was significantly associated with a 41% increase in requests (incidence rate ratio, 1.41; 95% CI, 1.31-1.51; P < .001), and a 10% increase in the population living below the federal poverty level was significantly associated with a 20% increase in requests (incidence rate ratio, 1.20; 95% CI, 1.13-1.28; P < .001). In this cross-sectional study, clinic access barriers were the most commonly cited reason for requesting self-managed medication abortion using an online telemedicine service. At the county level, distance to an abortion clinic and living below the federal poverty level were associated with a higher rate of requests. State and federal legislation could address these access barriers.
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影响因子：
9.8
作者：
Aiken, Abigail R. A.;Broussard, Kathleen;Scott, James G.
通讯作者：
Scott, James G.
DOI：
10.1111/1471-0528.16668
发表时间：
2021-08
期刊：
BJOG : an international journal of obstetrics and gynaecology
影响因子：
--
作者：
Aiken A;Lohr PA;Lord J;Ghosh N;Starling J
通讯作者：
Starling J
影响因子：
5.8
作者：
Jerman, Jenna;Frohwirth, Lori;Blades, Nakeisha
通讯作者：
Blades, Nakeisha
影响因子：
13.8
作者：
Brown BP;Hebert LE;Gilliam M;Kaestner R
通讯作者：
Kaestner R
影响因子：
2.9
作者：
Murtagh, Chloe;Wells, Elisa;Winikoff, Beverly
通讯作者：
Winikoff, Beverly