Hannah McCulloch, Sarah Salkeld, Melissa J Palmer, Kayleigh Hills, Jonathan Lord, Amy Green, Patricia A Lohr
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引用次数: 0
Abstract
Purpose: No-test medication abortion involves a teleconsultation, gestational age dating by last menstrual period (LMP), and home-use of medicines. In England and Wales, British Pregnancy Advisory Service (BPAS) and MSI Reproductive Choices UK (MSIUK) began offering no-test medication abortion to patients of all ages with pregnancies ≤69 days' gestation in April 2020. In May 2021, BPAS changed policy; adolescents aged 15 years and less could initiate care via teleconsultation but must have an in-person safeguarding assessment review (screening for harm/abuse/neglect), and an ultrasound. We assessed the impact of this change on accessibility, safeguarding, and gestational age estimation.
Methods: We compared waiting time from first contact to abortion, abortions conducted at ≤6 and ≤10 weeks' gestation, and safeguarding referrals to support organizations using routine data from BPAS or MSIUK for abortion patients aged 15 years and less over 5 months before and after BPAS' policy change. For BPAS patients postpolicy change, we determined safeguarding referral source (teleconsultation/in-person) and diagnostic accuracy of LMP and other menstrual history features versus ultrasound for determining gestational age.
Results: Between December 1, 2020 and September 30, 2021, 614 adolescents were treated. Postpolicy change, median waiting time from the first contact to abortion at BPAS significantly increased (7 vs. 11 days, p < .001) and proportion of abortions provided within 1 week of contact decreased (52.7% vs. 25.9%, p < .01). Both were stable at MSIUK (9 vs. 9 days [p = .59]; 38.2% vs. 39.2% [p = .99]). At BPAS, all indicated safeguarding referrals were identified at initial teleconsultation. Ten of 201 BPAS patients (5.0%) became ineligible for medication abortion (gestation > 69 days) while waiting for routine ultrasound; both LMP and ultrasound dating suggested eligibility (gestation ≤ 69 days) at first contact.
Discussion: Requiring in-person adolescent consultation is associated with reduced access to medication abortion without enhancing safeguarding.
期刊介绍：
The Journal of Adolescent Health is a scientific publication dedicated to enhancing the health and well-being of adolescents and young adults. Our Journal covers a broad range of research topics, spanning from the basic biological and behavioral sciences to public health and policy. We welcome a variety of contributions, including original research papers, concise reports, literature reviews, clinical case reports, opinion pieces, and letters to the editor. We encourage professionals from diverse disciplines such as Anthropology, Education, Ethics, Global Health, Health Services Research, Law, Medicine, Mental and Behavioral Health, Nursing, Nutrition, Psychology, Public Health and Policy, Social Work, Sociology, and Youth Development to share their expertise and contribute to our mission of promoting adolescent health. Moreover, we value the voices of young individuals, family and community members, and healthcare professionals, and encourage them to submit poetry, personal narratives, images, and other creative works that provide unique insights into the experiences of adolescents and young adults. By combining scientific peer-reviewed research with creative expressions, our Journal aims to create a comprehensive understanding of the challenges and opportunities in adolescent and young adult health.
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