Patient and provider experiences using a site-to-site telehealth model for medication abortion

Abstract

Background: In the site-to-site telehealth for medication abortion model, patients visit a health center to meet with a remote clinician using telehealth technology. This model is safe, effective, and acceptable to patients and providers. The objective of this study was to document the experiences of patients and providers using telehealth for medication abortion in Planned Parenthood health centers across different geographical contexts in the United States.Methods: We conducted in-depth interviews with Planned Parenthood medication abortion patients who either met with a clinician at the clinic via telehealth or in-person about their experiences receiving care. We also interviewed Planned Parenthood staff members about their experiences implementing telehealth for medication abortion at their health center. Results:We interviewed 29 patients who received care at Planned Parenthood health centers in five states. Both telehealth and in-person patients described positive interactions with health center staff and clinicians. The vast majority of telehealth patients said that they felt comfortable speaking with the clinician over telehealth and had no trouble using the telehealth technology. We interviewed 12 providers, including clinicians and administrative staff, who worked in seven states. Providers largely thought that telehealth for medication abortion expanded access to medication abortion.Conclusions: Across different locations, our findings indicate that patients found telehealth for medication abortion services to be highly acceptable and providers found that telehealth services may help improve medication abortion access. As the use of telehealth for medication abortion expands, future research should include additional measures of quality to ensure that services are acceptable across different identities and experiences, including age, race, gender, and income level.

Patient Perspectives Regarding Clinician Communication During Telemedicine Compared With In-Clinic Abortion

“…21,22 In contrast to a prior qualitative study in which some telemedicine participants stated they felt reduced personal interactions with their clinician than if they had seen them in-clinic, we detected no such difference. 23 This present study found that many of the patient–clinician interactions were consistent with behaviors and attributes associated with patient-centered communication. In essence, we showed that patient-centered communication qualities traditionally provided in the in-person abortion care setting can readily be translated to live, face-to-face video telemedicine.…”

Telemedicine Abortion

“…14,47 Most patients would recommend the telemedicine abortion service to a friend, 6,14,15,47,50,57,58 and between 66% 56 and 97.7% 58 stated that they would choose the service in the future. 14,15,24,36,43,45,47,52,54,56 Patients across multiple studies reported that they were satisfied with their experience, 59 felt comfortable using the telehealth service 60 and had positive experiences with their abortion provider. 59,61,62 Grindlay et al 62 reported that patients felt more comfortable asking questions during a telemedicine visit because of internalized or anticipated abortion stigma that would have been exacerbated by speaking to a provider in person.…”

“…56 Some patients mentioned concerns regarding privacy during their conversation with a clinician and would have preferred to meet with a clinician in person due to these concerns. 60 Alternatively, many patients perceived that an in-person clinic visit may be less private, particularly if they were recognized at the clinic, a concern alleviated through telemedicine abortion by mail. 23,58 As telemedicine abortion appointments provided patients with greater flexibility, the need to take time off work and disclose their abortion to colleagues was obviated, which gave patients a greater sense of privacy.…”

“…6,23 Some patients had logistical concerns with the telemedicine abortion service, stating that it was easier to hear their provider over the telephone than over web conference, and others reported nonspecific technical difficulties. 23,57,60 While these technical issues are inherent to the use of telemedicine in any specialty, providers who are unable to communicate effectively with their patients over web conference should ensure the availability of an alternative method of communication such as a telephone call so that patients always receive counseling consistent with the standard of care. Asynchronous telemedicine models can eliminate some of these technical issues.…”

“…Participants perceived the level of privacy in their telemedicine appointment to be better than or equal to the privacy they expected in an in-person visit, 59,62 and 95.3% of patients in one study were able to talk privately during the telemedicine appointment with no issues, while the remaining 4.6% of patients had to take action to be able to talk privately (ie, go to their car, obtain childcare) 56 . Some patients mentioned concerns regarding privacy during their conversation with a clinician and would have preferred to meet with a clinician in person due to these concerns 60 . Alternatively, many patients perceived that an in-person clinic visit may be less private, particularly if they were recognized at the clinic, a concern alleviated through telemedicine abortion by mail 23,58 .…”