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Patient concerns about accessing sexual and reproductive health services outside of primary care: A survey in rural and urban settings in the Pacific Northwest

      Abstract

      Objectives

      While primary care providers are a major source of sexual and reproductive health (SRH) services in the United States, particularly in rural areas, not all primary care settings offer a full range of SRH services. We aimed to understand primary care patient concerns regarding accessing SRH services, including abortion care, outside of their primary care clinic and if those concerns differed by urban or rural setting.

      Study design

      An anonymous survey was distributed over a 2-week period between December 2019 to March 2020 to all adult patients in four primary care clinics in Idaho, Washington, and Wyoming. The survey assessed patient concerns regarding accessing SRH services outside of their primary care clinic and their willingness to travel to access SRH services.

      Results

      The overall response rate was 69% (745/1086). Over 85% of respondents identified at least one concern to seeking SRH services outside of a primary care setting, with cost, insurance coverage, length of wait time, and lack of an established relationship being the most frequently reported concerns. A majority of respondents were willing to travel a maximum of 1 hour for most SRH services. Respondents from rural-serving clinics were significantly more likely to be willing to travel longer amounts of time for medication abortion, aspiration abortion, and intrauterine device placement.

      Conclusion

      Our findings highlight that a majority of both urban and rural primary care patients have concerns regarding accessing SRH services outside of their primary care clinic and are unwilling to travel more than 1 hour to access most SRH services.

      Implications

      A majority of primary care patients have concerns regarding accessing SRH services outside of primary care settings. Health care policy changes should aim to strengthen the SRH services available in primary care settings to alleviate the burdens primary care patients face in accessing SRH services outside of their primary care clinic, particularly for rural populations.

      Keywords

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      References

        • American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Women
        Committee opinion no. 654: reproductive life planning to reduce unintended pregnancy.
        Obstet Gynecol. 2016; 127: e66-e69https://doi.org/10.1097/AOG.0000000000001314
        • Johnson K
        • Posner SF
        • Biermann J
        • Cordero J
        • Atrash H
        • Parker C
        • et al.
        Recommendations to improve preconception health and health care–United States. A report of the CDC/ATSDR preconception care work group and the select panel on preconception care.
        MMWR Recomm Rep. 2006; 55: 1-23
      1. Department of Health and Human Services. Healthy people 2020 topics and objectives: family planning, http://www.healthypeople.gov/2020/topics-objectives/topic/family-planning; 2022 (accessed April 22, 2022).

        • Brandt CMA
        • Shire MA
        • Wilson G
        • Ito K.
        Addressing organizational barriers to adolescent access to high-quality, low-cost, confidential sexual and reproductive health services in a community health center.
        Health Promot Pract. 2021; (Published online January 15)1524839920985505https://doi.org/10.1177/1524839920985505
        • Stone RH
        • Griffin B
        • Fusco RA
        • Vest K
        • Tran T
        • Gross S
        Factors affecting contraception access and use in patients with opioid use disorder.
        J Clin Pharmacol. 2020; 60: S63-S73https://doi.org/10.1002/jcph.1772
        • Alhusen JL
        • Bloom T
        • Laughon K
        • Behan L
        • Hughes RB.
        Perceptions of barriers to effective family planning services among women with disabilities.
        Disabil Health J. 2021; 14101055https://doi.org/10.1016/j.dhjo.2020.101055
        • Paisi M
        • March-McDonald J
        • Burns L
        • Snelgrove-Clarke E
        • Withers L
        • Shawe J.
        Perceived barriers and facilitators to accessing and utilizing sexual and reproductive healthcare for people who experience homelessness: a systematic review.
        BMJ Sex Reprod Health. 2021; 47: 211-220https://doi.org/10.1136/bmjsrh-2020-200799
        • Beshar I
        • So J
        • Chelvakumar M
        • Cahill EP
        • Shaw KA
        • Shaw JG.
        Socioeconomic differences persist in use of permanent vs long-acting reversible contraception: an analysis of the National Survey of Family Growth, 2006 to 2010 vs 2015 to 2017.
        Contraception. 2021; 103: 246-254https://doi.org/10.1016/j.contraception.2020.12.008
        • Bossick AS
        • Brown J
        • Hanna A
        • Parrish C
        • Williams EC
        • Katon JG
        Impact of state-level reproductive health legislation on access to and use of reproductive health services and reproductive health outcomes: a systematic scoping review in the affordable care act era.
        Womens Health Issues. 2020; 31: 114-121https://doi.org/10.1016/j.whi.2020.11.005
        • Charlton BM
        • Everett BG
        • Light A
        • Jones R
        • Janiak E
        • Gaskins A
        • et al.
        Sexual orientation differences in pregnancy and abortion across the lifecourse.
        Women's Health Issues. 2020; 30: 65-72https://doi.org/10.1016/j.whi.2019.10.007
        • Hudson GM.
        Factors influencing contraception use in sexual minority women: A systematic literature review [Master's alternative plan paper.
        Cornerstone: A Collection of Scholarly and Creative Works for Minnesota State University, Mankato, Minnesota State University, Mankato]2021 (https://cornerstone.lib.mnsu.edu/etds/1091/ (accessed April 22, 2022))
        • Bearak JM
        • Burke KL
        • Jones RK.
        Disparities and change over time in distance women would need to travel to have an abortion in the USA: a spatial analysis.
        Lancet Public Health. 2017; 2: e493-e500https://doi.org/10.1016/S2468-2667(17)30158-5
        • Fuentes L
        • Jerman J.
        Distance traveled to obtain clinical abortion care in the United States and reasons for clinic choice.
        J Women's Health (Larchmt). 2019; 28: 1623-1631https://doi.org/10.1089/jwh.2018.7496
      2. ACOG committee opinion no. 586: health disparities in rural women.
        Obstet Gynecol. 2014; 123: 384-388https://doi.org/10.1097/01.AOG.0000443278.06393.d6
        • Cohen D
        • Coco A.
        Trends in the provision of preventive women's health services by family physicians.
        Fam Med. 2011; 43: 166-171
        • The Robert Graham Center
        The family physician workforce: the special case of rural populations.
        Am Fam Physician. 2005; 72: 147
        • Dobbs
        v. Jackson Women's Health Organization et. al. 597. State Health Officer of the Mississippi Department of Health, 2022
        • Miles C
        • Weidner A
        • Summit AK
        • Thomson CJ
        • Zhang Y
        • Cole AM
        Patient opinions on sexual and reproductive health services in primary care in rural and urban clinics.
        Contraception. 2022; 114 (Epub 2022 Apr 27. PMID: 35489391): 26-31https://doi.org/10.1016/j.contraception.2022.04.009
        • US Department of Agriculture
        Rural-Urban Continuum Codes.
        2020 (https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx (accessed April 22, 2022))
        • Cole A
        • Keppel GA
        • Linares A
        • Alto W
        • Kriegsman W
        • Reed A
        • et al.
        Evaluating the development, implementation and dissemination of a multisite card study in the WWAMI region practice and research network.
        Clin Transl Sci. 2015; 8: 764-769https://doi.org/10.1111/cts.12312
        • Harris PA
        • Taylor R
        • Thielke R
        • Payne J
        • Gonzalez N
        • Conde JG.
        Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381https://doi.org/10.1016/j.jbi.2008.08.010
        • Harris PA
        • Taylor R
        • Minor BL
        • Elliott V
        • Fernandez M
        • O'Neal L
        • et al.
        The REDCap consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208https://doi.org/10.1016/j.jbi.2019.103208
      3. Wood S, Strasser J, Sharac J, Wylie J, Tran T, Rosenbaum S. Community health centers and family planning in an era of policy uncertainty, https://www.kff.org/report-section/community-health-centers-and-family-planning-in-an-era-of-policy-uncertainty-report; 2018 (accessed April 22, 2022).

        • Anthony C.
        A Biopsy Came With An Unexpected $2,170 “Cover Charge” For The Hospital.
        NPR, 2019 (https://www.npr.org/sections/health-shots/2019/09/30/764795892/a-biopsy-came-with-an-unexpected-2-170-cover-charge-for-the-hospital (accessed April 22, 2022))
        • Goldberg D
        • Sahgal B
        • Beeson T
        • Wood S
        • Mead H
        • Abdul-Wakil A
        • et al.
        Patient perspectives on quality family planning services in underserved areas.
        Patient Exp J. 2017; 4: 54-65https://doi.org/10.35680/2372-0247.1194
        • Dunlop AL
        • Logue KM
        • Miranda MC
        • Narayan DA.
        Integrating reproductive planning with primary health care: an exploration among low-income, minority women and men.
        Sex Reprod Healthc. 2010; 1: 37-43https://doi.org/10.1016/j.srhc.2010.01.001
        • Jones HE
        • Calixte C
        • Manze M
        • Perlman M
        • Rubin S
        • Roberts L
        • et al.
        Primary care patients’ preferences for reproductive health service needs assessment and service availability in New York federally qualified health centers.
        Contraception. 2020; 101: 226-230https://doi.org/10.1016/j.contraception.2019.12.003
        • Machado SR
        • Jayawardana S
        • Mossialos E
        • Vaduganathan M.
        Physician density by specialty type in urban and rural counties in the US, 2010 to 2017.
        JAMA Netw Open. 2021; 4e2033994https://doi.org/10.1001/jamanetworkopen.2020.33994
        • Logsdon MB
        • Handler A
        • Godfrey EM.
        Women's preferences for the location of abortion services: a pilot study in two Chicago clinics.
        Matern Child Health J. 2012; 16: 212-216https://doi.org/10.1007/s10995-010-0722-4
        • Rubin SE
        • Godfrey E
        • Gold M
        Patient attitudes toward early abortion services in the family medicine clinic.
        J Am Board Fam Med. 2008; 21: 162-164https://doi.org/10.3122/jabfm.2008.02.070158
        • Jones RK
        • Jerman J.
        Abortion incidence and service availability In the United States, 2014.
        Perspect Sex Reprod Health. 2017; 49: 17-27https://doi.org/10.1363/psrh.12015
        • Jones RK
        • Jerman J.
        How far did US women travel for abortion services in 2008?.
        J Womens Health (Larchmt). 2013; 22: 706-713https://doi.org/10.1089/jwh.2013.4283
        • White K.
        Out-of-state travel for abortion following implementation of Texas senate bill 8.
        Tex Policy Eval Proj. 2022; (https://sites.utexas.edu/txpep/files/2022/03/TxPEP-out-of-state-SB8.pdf (accessed August 6, 2022))
        • Redd SK
        • Rice WS
        • Aswani MS
        • Blake S
        • Julian Z
        • Sen B
        • et al.
        Racial/ethnic and educational inequities in restrictive abortion policy variation and adverse birth outcomes in the United States.
        BMC Health Serv Res. 2021; 21: 1139https://doi.org/10.1186/s12913-021-07165-x
        • Kortsmit K
        • Mandel MG
        • Reeves JA
        • Clark E
        • Pagano HP
        • Nguyen A
        • et al.
        Abortion surveillance — United States, 2019.
        MMWR Surveill Summ. 2021; 70: 1-29https://doi.org/10.15585/mmwr.ss7009a1
        • Upadhyay UD
        • Raymond EG
        • Koenig LR
        • Coplon L
        • Gold M
        • Kaneshiro B
        • et al.
        Outcomes and safety of history-based screening for medication abortion.
        JAMA Intern Med. 2022; (Published online March 21)https://doi.org/10.1001/jamainternmed.2022.0217
        • Aiken A
        • Lohr PA
        • Lord J
        • Ghosh N
        • Starling J.
        Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.
        BJOG. 2021; 128: 1464-1474https://doi.org/10.1111/1471-0528.16668
      4. Society of Family Planning. Interim clinical recommendations: contraceptive provision when healthcare access is restricted due to pandemic response.; 2020. doi:10.46621/UYGR2287

        • Ellison J
        • Cole MB
        • Thompson TA.
        Association of telehealth reimbursement parity with contraceptive visits during the covid-19 pandemic.
        JAMA Netw Open. 2022; 5e226732https://doi.org/10.1001/jamanetworkopen.2022.6732
        • The Center for Health Law and Policy Innovation of Harvard Law School (CHLPI)
        Farmworker justice, campesinos sin Fronteras, vista community clinic.
        Promise Telehealth. 2018; (https://www.farmworkerjustice.org/resource/the-promise-of-telehealth-increasing-access-to-quality-healthcare-in-rural-america/ (accessed August 6, 2022))
        • Samuels K
        • McClellan M
        • Patel K
        • Darling M.
        Transforming rural health care: high-quality, sustainable access to specialty care.
        Health Affairs Blog. 2015; (https://www.brookings.edu/opinions/transforming-rural-health-care-high-quality-sustainable-access-to-specialty-care/ (accessed August 6, 2022))
        • Chong E
        • Shochet T
        • Raymond E
        • Platais I
        • Anger HA
        • Raidoo S
        • et al.
        Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic.
        Contraception. 2021; 104: 43-48https://doi.org/10.1016/j.contraception.2021.03.019
        • Casas RS
        • Prifti CA
        • Bachorik AE
        • Stuckey H
        • Sobota M
        • Chuang CH
        • et al.
        Contraceptive procedures in internal medicine clinics and resident education: a qualitative study of implementation methods, barriers, and facilitators.
        J Gen Intern Med. 2021; 36: 3346-3352https://doi.org/10.1007/s11606-021-06832-3
        • Geary M
        • Prifti C
        • Bachorik A.
        Residency training in long-acting reversible contraceptive methods.
        JAMA Intern Med. 2017; 177: 1061https://doi.org/10.1001/jamainternmed.2017.2101
        • Botfield JR
        • Wright SM
        • Fenwick SE
        • Cheng Y.
        Training nurses in contraceptive implant procedures: implications for practice in Australia.
        Collegian. 2021; 28: 114-120https://doi.org/10.1016/j.colegn.2020.04.005
        • Harper CC
        • Stratton L
        • Raine TR
        • Thompson K
        • Henderson JT
        • Blum M
        • et al.
        Counseling and provision of long-acting reversible contraception in the US: National survey of nurse practitioners.
        Prev Med. 2013; 57: 883-888https://doi.org/10.1016/j.ypmed.2013.10.005
        • Wallace R
        • Shih G.
        Complex family planning - demarginalizing abortion care requires uplifting primary care and non-CFP providers.
        Contraception. 2022; 105: 86https://doi.org/10.1016/j.contraception.2021.05.023
        • Alsaden I.
        Why Are Fellow OB-GYNs Making My Job as an Abortion Provider Even More Difficult?.
        Rewire News Group, 2021 (https://rewirenewsgroup.com/article/2021/12/18/why-are-fellow-ob-gyns-making-my-job-as-an-abortion-provider-even-more-difficult/ (accessed April 22, 2022))
      5. ACGME. ACGME program requirements for graduate medical education in complex family planning. https://www.acgme.org/globalassets/pfassets/programrequirements/236_complexfamilyplanning_2020-06-13.pdf; 2020 (accessed April 22, 2022).