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To understand how patients decide whether to choose direct-to-patient telehealth or in-clinic services for medication abortion care.
This qualitative study used in-depth, semi-structured interviews collected from September 2021 to January 2022 and analyzed using inductive-deductive constant comparative analysis. We conducted 30 one-on-one, one-hour remote interviews with participants who received a medication abortion from a high-volume reproductive healthcare clinic in Washington State (20 telehealth, 10 in-clinic). Outcomes included clinic and patient sociodemographic and psychological factors from the Patient Choice and Empowerment Framework. Interviews were recorded, transcribed, and quality checked; major themes were identified and summarized.
The majority of those interviewed were aged 30–35 (56.7%) and half were in the first six weeks of their pregnancy at time of care (50.0%). Six individuals (20%) self-identified as Hispanic/Latino, five (17%) as Non-Hispanic White, and 10 (33%) as Non-Hispanic, other race. How soon a clinic appointment was available was the most important consideration for choosing modality of care, with high value placed on same-day or next-day appointments. Participants preferred telehealth services to in-person services due to (1) convenience, (2) less disruption from other responsibilities at home or work, (3) familiarity of telehealth due to increased use during the COVID-19 pandemic, and (4) less stigmatization of being in-person. Participants who chose in-clinic services over telehealth options did so to ensure their care was legitimate.
Both telehealth and in-clinic medication abortion services meet different patient needs. Providing patients with a choice about modality for care meets these diverse needs and allows for more accessible and satisfactory services.
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