A qualitative study of abortion care providers’ perspectives on telemedicine medical abortion provision in the context of COVID-19

Abstract

BackgroundTelemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs).MethodsQualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically.ResultsWe present three themes from our qualitative analysis: (1) Selective use of ultrasound – the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues – in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation – telephone consultations were considered more focused than in-person consultations and formed only part of the overall ‘package’ of information provided to patients, supplemented by online and written information.ConclusionsACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.

Early telemedical abortion, safeguarding, and under 18s: a qualitative study with care providers in England and Wales

“…Our findings are consistent with a qualitative study from Scotland about ACPs’ experiences of TEMA during COVID-19 in which safeguarding was a theme constructed in the data. 21 …”

Safeguarding for reproductive coercion and abuse

“…The policy concerns over RCA and telemedicine abortion are a further illustration of abortion exceptionalism. Despite healthcare professionals reporting that they are able to recognise behavioural indicators such as changes to tone of voice and language during telemedicine consultations,11 and an increase in safeguarding disclosures in British abortion settings when the telemedical service was introduced,12 13 many policymakers have raised objections to continuing the service because of concerns that safeguarding responsibilities would not be as effective during virtual consultations. This was particularly the case for telemedicine for young people, despite evidence that the move to online sexual health services, which in some cases pre-dated COVID-19, had also increased safeguarding disclosures 12 14.…”

“Almost like it was really underground”: a qualitative study of women’s experiences locating services for unintended pregnancy in a rural Australian health system

“…Healthcare providers themselves have acknowledged that much clearer information about all pregnancy options including “no touch” or telehealth abortion services should be more accessible to women and practitioners alike. 19 , 48 , 49 Mandating publicly funded abortion services to be made available at all public hospitals, including in regional and remote areas, will go a long way in reducing fragmentation and improving timely, low cost, close-to-home access for the woman. It will also offer reassurance and “back-up” support to those primary care providers currently offering abortion services in isolation, and may encourage more rural GPs to become EMA prescribers.…”