Comparison of interpersonal quality of contraceptive counseling delivered via telehealth versus in person.

OBJECTIVES: This study aimed to compare the interpersonal quality of contraceptive counseling between telehealth and in-person visits. STUDY DESIGN: Patients at a single Title X-funded clinic selected their preferred counseling modality (in person or telehealth via video or telephone) when scheduling an appointment for contraception. After counseling, we invited patients to complete a survey and recorded their desired contraceptive method. We assessed the quality of counseling using the Interpersonal Quality in Family Planning scale. We reviewed the electronic medical record to identify any subsequent clinician visit. We performed between-group comparisons using Mann-Whitney U, χ2, and Fisher exact tests. RESULTS: From March 2021 to June 2022, 360 patients were eligible to participate, and 296 (82%) completed the survey and were included in the analysis; 150 (51%) completed counseling in person, and 146 (49%) completed counseling via telehealth. In the telehealth group, 102 (70%) chose telephone, and 44 (30%) chose video. Respondent characteristics were similar between groups. The majority of respondents in both groups reported high quality of counseling, defined as a top score on the Interpersonal Quality in Family Planning scale (75.0% telehealth respondents and 80.0% in person, p = 0.30). Compared to respondents completing in-person counseling, telehealth respondents were less likely to have a subsequent clinician visit (89.0% versus 100.0%, p < 0.001). CONCLUSIONS: The majority of respondents reported high-quality contraceptive counseling without significant difference between the modalities. However, respondents choosing telehealth were less likely to have a subsequent clinician visit. Given the higher uptake of telephone compared to video, telehealth via telephone may be more accessible or acceptable to some patients. IMPLICATIONS: Contraceptive counseling via telehealth has similar high interpersonal quality when compared to traditional, in-person visits. However, barriers may exist for patients who choose telehealth contraceptive counseling to access subsequent in-person care. Utilization of telehealth for contraceptive visits may provide opportunities for more equitable health care and to expand contraceptive access.

Comparison of Early Pregnancy Loss Management Between States With Restrictive and Supportive Abortion Policies.

INTRODUCTION: Mifepristone-misoprostol and office uterine aspiration used for abortion care are also evidence-based, cost-effective strategies for early pregnancy loss management. We aimed to compare the provision of mifepristone-misoprostol and office uterine aspiration for early pregnancy loss between states with restrictive and supportive abortion policies. METHODS: We conducted a cross-sectional, internet-based survey regarding early pregnancy loss management among obstetrician-gynecologists (OBGYNs) at academic medical centers. We assessed management offered along with facilitators and barriers to implementation of mifepristone-misoprostol and office uterine aspiration. We used χ2 and multivariable logistic regression to compare practice patterns. RESULTS: We analyzed responses from 350 physicians, 56% from states with restrictive abortion policies. OBGYNs in states with restrictive abortion policies were less likely than those in states with supportive abortion policies to offer both mifepristone-misoprostol and office uterine aspiration (33.2% vs. 51.3%; p = .001), to report having received induced abortion training (67.3% vs. 89.6%; p < .001), and to report perceived institutional support for abortion care (49.0% vs. 85.0%; p < .001). After adjusting for confounders, restrictive state policy was no longer associated with providing both mifepristone-misoprostol and office uterine aspiration for early pregnancy loss (adjusted odds ratio, 1.19; 95% confidence interval [CI], 0.58-2.45). However both prior induced abortion training and institutional support for abortion care remained significantly associated (adjusted odds ratio, 2.06; 95% CI, 1.07-3.97 and adjusted odds ratio, 3.91; 95% CI, 2.08-7.38, respectively). CONCLUSIONS: OBGYNs practicing in states with restrictive abortion policies are less likely than those in states with supportive abortion policies to have received abortion training or perceive institutional support for abortion care, and they are less likely to offer mifepristone-misoprostol and office uterine aspiration for early pregnancy loss.

Young women's preferences for contraceptive education & development of an online educational resource.

Objectives: To explore young women's preferences for contraceptive education to inform the development of an educational resource and to pilot test the resource with patients and clinicians. Methods: We performed a mixed-methods study to elicit preferences for contraceptive educational resources among patients, develop an online resource, and pilot test the resource with clinicians and patients to assess feasibility, systems usability, and contraceptive knowledge. Results: Forty-one women aged 16-29 completed in-depth interviews: they preferred an online format which was recommended by a clinician, presented contraceptive methods in order of effectiveness, and contained information from experts and experiences from individual users. We adapted an existing website (bedsider.org) to create an online educational resource. Thirty clinicians and thirty patients completed surveys after use. System Usability Scale scores were high among patients (median [IQR]: 80 [72-86]) and clinicians (84 [75-90]). Patients answered more contraceptive knowledge questions correctly after interacting with the resource (9.9±2.7 vs 12.0±2.8, p<0.001). Conclusions: We developed a contraceptive educational resource incorporating end-user feedback that was highly usable and increased patients' contraceptive knowledge. Future research should assess effectiveness and scalability among a larger sample of patients. Innovation: This contraceptive educational resource can supplement clinician counseling to increase patient contraceptive knowledge.

Differences in Financial and Social Burdens Experienced by Patients Traveling for Abortion Care.

OBJECTIVE: We compared perceived stress between women traveling 50 or fewer miles and more than 50 miles for abortion care. Secondary objectives were to compare individual-level stigma and hardship scores in patients by distance traveled to the clinic. METHODS: We performed a cross-sectional study of patients presenting for care at an independent abortion clinic in southern Illinois. Participants completed a self-administered, tablet computer-based survey asking about their experiences seeking abortion, including the Perceived Stress Scale (PSS) and Individual Level Abortion Stigma (ILAS) scale. We created a composite score to characterize patient hardship regarding abortion care (range, 0-4). We examined responses stratified by the patients' self-reported one-way distance traveled to the clinic (group 1, ≤50 miles; group 2, >50 miles). RESULTS: A total of 308 women completed the survey. There was no significant difference in mean PSS scores (p = .71) or median ILAS scores (p = .40) between groups. A majority of the cohort reported moderate or high stress (68.2%). The median hardship score was significantly higher in the greater than 50 mile group (median, 1 [interquartile range, 0-2] vs. 2 [interquartile range 1-3]; p < .001). Patients who traveled more than 50 miles reported difficulties related to missing work (58.3%), delays in obtaining an abortion owing to financial costs (35.7%), lodging (13.9%), and transportation (11.3%). CONCLUSIONS: There was no difference in PSS or ILAS scores by distance traveled among patients seeking an abortion; however, patients who traveled more than 50 miles had a higher hardship score, suggesting greater difficulty accessing abortion. The most common difficulties encountered included missing time from work and financial costs associated with the abortion.

Young women's preferences for contraceptive education: The importance of the clinician in three U.S. health centers in 2017-2018.

OBJECTIVE: We explored women's preferences for contraceptive education and assess the role of the clinician in delivering this education in three U.S. health centers in 2017-2018. STUDY DESIGN: We recruited women ages 16 to 29 presenting for gynecologic care at 3 clinical sites. Respondents completed a survey about preferences for receipt of contraceptive information and trustworthiness of information sources. RESULTS: We included 270 respondents' surveys (77.6% of approached). Clinicians were the most preferred (87.0%) and trusted (83.5%) source of contraceptive information, and 69.0% said a clinician's recommendation made a source more trustworthy. CONCLUSIONS: Clinicians are a trusted source of contraceptive information; their recommendations of other educational resources may improve acceptance by patients.

Creating an Intensive Care Unit From a Postanesthesia Care Unit for the COVID-19 Surge at the Veterans Affairs Ann Arbor Healthcare System.

OBJECTIVES: To prepare for the predicted surge of patients with COVID-19 in Southeast Michigan, the US Department of Veterans Affairs Ann Arbor Healthcare System engineered, built, and staffed a 12-bed intensive care unit (ICU) from the existing postanesthesia care unit (PACU). OBSERVATIONS: Considerations including floor planning, reversal of airflow, strict airborne precautions, sealing off a dedicated nursing station, and developing an infection control plan in an open care unit. A staffing model was created that included anesthesiologist intensivists, advanced practice providers, residents, certified registered nurse anesthetists, and perioperative nurses working alongside ICU trained nurses. Challenges arose in infection control, communication, mechanical ventilation using anesthesia machines, providing renal replacement therapy, and maintaining patient privacy in an open unit. CONCLUSIONS: This article describes the setup, challenges, and solutions that allowed the creation of the PACU-ICU to help serve veterans and civilians during a time of unprecedented strain on the health care system due to COVID-19.