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P043Southern health providers’ perspectives on policy considerations for implementation of telehealth medication abortion services

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      Objectives

      The Southeastern US has increased restrictions on abortion. Medication abortion provision via telehealth may connect those in the region to necessary abortion services, but evidence on implementation of this service, particularly considering state and organizational policies, is lacking. We explored providers’ understanding and perceptions of existing state-level and organizational policies related to  medication abortion provision via telehealth, potential impact on their practice, and their perceptions of recent changes to telemedicine policies nationally. 

      Methods

      Semi-structured interviews with 21 administrators and clinicians in 13 Southeastern states (September–November 2021) were audio-recorded, transcribed verbatim, and analyzed using MaxQDA. A codebook was developed based on an initial set of transcripts and further refined by consensus and assessment of intercoder reliability. Transcripts were thematically analyzed utilizing constant comparative method.

      Results

      All participants identified of state policies that constrained their medication abortion service delivery beyond telemedicine bans. Most respondents felt high anxiety because of the changing policy landscape and discussed the lifting of Risk Evaluation and Mitigation Strategy on mifepristone as resulting in little change to their practice. Most participants discussed adjacent state-level policies, eg, ultrasound viewing laws, as posing salient barriers to medication abortion provision via telehealth. Some cited clinic/organizational policies, such as ultrasound waivers, as acting as buffers to the burdens posed by state-level restrictions and facilitators for provision of this service.

      Conclusions

      For participants, state-level telemedicine bans were not the primary barrier to medication abortion provision via telehealth, with most citing another law making the service infeasible. In light of the Dobbs v. Jackson Women's Health Organization decision, further attention should be paid to organizational policies, which may support unbundling of telehealth medication abortion and ensure abortion access for Southerners.
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