Hannah McCulloch, Sarah Salkeld, Melissa J Palmer, Kayleigh Hills, Jonathan Lord, Amy Green, Patricia A Lohr
{"title":"评估英格兰和威尔士青少年人工流产护理常规要求的影响：一项事后评估。","authors":"Hannah McCulloch, Sarah Salkeld, Melissa J Palmer, Kayleigh Hills, Jonathan Lord, Amy Green, Patricia A Lohr","doi":"10.1016/j.jadohealth.2024.12.016","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>Requiring in-person adolescent consultation is associated with reduced access to medication abortion without enhancing safeguarding.</p>","PeriodicalId":56278,"journal":{"name":"Journal of Adolescent Health","volume":" ","pages":""},"PeriodicalIF":5.5000,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessing the Impact of a Routine Requirement for In-Person Abortion Care for Adolescents in England and Wales: A Prepost Evaluation.\",\"authors\":\"Hannah McCulloch, Sarah Salkeld, Melissa J Palmer, Kayleigh Hills, Jonathan Lord, Amy Green, Patricia A Lohr\",\"doi\":\"10.1016/j.jadohealth.2024.12.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Discussion: </strong>Requiring in-person adolescent consultation is associated with reduced access to medication abortion without enhancing safeguarding.</p>\",\"PeriodicalId\":56278,\"journal\":{\"name\":\"Journal of Adolescent Health\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":5.5000,\"publicationDate\":\"2025-02-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Adolescent Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jadohealth.2024.12.016\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Adolescent Health","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jadohealth.2024.12.016","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：无测试药物流产包括远程咨询，胎龄确定的最后一次月经（LMP），和家庭使用的药物。在英格兰和威尔士，英国妊娠咨询服务中心（BPAS）和英国MSI生殖选择中心（MSIUK）于2020年4月开始为怀孕≤69天的所有年龄段的患者提供无检测药物流产服务。2021年5月，bpa改变了政策；15岁及以下的青少年可以通过远程咨询开始护理，但必须进行面对面的保障评估审查（筛查伤害/虐待/忽视）和超声波检查。我们评估了这一变化对可及性、安全性和胎龄估计的影响。方法：我们比较了从初次接触到流产的等待时间，妊娠≤6周和≤10周流产的时间，以及在BPAS政策改变前后15岁及以下5个月的流产患者使用BPAS或MSIUK的常规数据转介到支持组织的保障时间。对于政策改变后的BPAS患者，我们确定了保障转诊来源（远程咨询/亲自）和LMP和其他月经史特征的诊断准确性，而不是超声来确定胎龄。结果：2020年12月1日至2021年9月30日，614名青少年接受了治疗。政策改变后，BPAS从首次就诊到流产的中位等待时间显著增加（7天vs. 11天，p < 0.01）， 1周内流产的比例下降（52.7% vs. 25.9%, p < 0.01）。两例患者在MSIUK均稳定（9天vs. 9天）[p = .59]；38.2% vs. 39.2% [p = .99])。在BPAS，所有指示的保护转诊在最初的远程咨询中被确定。201例BPAS患者中有10例（5.0%）在等待常规超声检查期间不符合药物流产（妊娠bb0 ~ 69天）；LMP和超声测年均提示初次接触时符合条件（妊娠≤69天）。讨论：要求青少年亲自咨询与药物流产的可及性减少有关，而没有加强保障。
Assessing the Impact of a Routine Requirement for In-Person Abortion Care for Adolescents in England and Wales: A Prepost Evaluation.
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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