番茄社区

SAN FRANCISCO -- A preference for audio-only telemedicine was one of five themes found among patients who had in-person or telemedicine contraception visits in Spanish, a small qualitative study of 20 patients in Southern California found.

Patients also had neutral to positive experiences with Spanish interpreters, and thus did not view the service as a barrier, reported Marielle Meurice, MD, of the University of California San Diego, at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.

Researchers sought to evaluate the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish through in-depth semi-structured interviews.

The team hypothesized that patients who used telemedicine "may encounter more language and technology barriers than those who have in-person visits" but have "improved access through conveniences and decreased need for transportation and childcare when applicable," Meurice said.

Five major themes emerged after analyzing the interviews. First, most patients preferred audio-only telemedicine visits for contraception and reported being less comfortable with video and being visible to the provider. Some patients said that the topic was embarrassing.

"You might have more biases when you see someone -- if you see their home, if you see their appearance -- that can potentially bias people in medicine as well, which we know is something that happens in contraception counseling," Meurice told 番茄社区.

The other major themes were:

• Participants didn't have difficulty with Spanish interpreters while using telemedicine.
• Telemedicine was convenient, especially related to time, work, childcare, and transportation, but it had some inconveniences related to method receipt.
• Some people were motivated to seek in-person care by a preference for comprehensive care, including a physical examination, as well as general familiarity with the in-clinic model versus the technology barriers from telemedicine.
• Patients trusted the privacy and confidentiality of the visits, but the level of privacy at home may impact the choice to receive in-person care.

"I think the key takeaway is that people can really decide for themselves what services are relevant to them," Meurice said.

One moderator noted that this research "represents the future of medicine" and that while some people will always want to be seen in person, a growing number of people want appointments conducted remotely in their native language.

For this study, patients were interviewed in Spanish following telemedicine or in-person contraception visits (10 each) that were conducted in Spanish. Community-based participatory research methods were utilized and researchers collaborated with a community advisory board that included local organizations -- such as California Latinas for Reproductive Justice and Latinos in Clinical Research -- as well as a telemedicine clinician and patient access specialist from Planned Parenthood Pacific Southwest.

Together, they devised and revised the interview guide, which was optimized for Spanish comprehension, and reviewed the interim and final analysis. The interview guide focused on language preferences, satisfaction with care, time, telemedicine conveniences and challenges, access to technology, and concerns about safety and privacy.

Visits took place at Planned Parenthood of the Pacific Southwest, which includes three counties in Southern California. Two coders analyzed the data and performed content analysis. Patients' average age was 33 and 65% had attended some college. Nearly all had publicly funded insurance (90%) and most (55%) chose a short-acting contraceptive method.

In San Diego County, a third of patients are Latine and prefer a non-English language, Meurice noted. They may also prefer language-concordant clinicians.

Prospective studies comparing the quality of telemedicine visits for contraception care among Spanish-speaking patients are needed in the future, Meurice added. Additionally, she hopes research compares in-person and telemedicine contraception counseling using the Person-Centered Contraceptive Counseling score, a validated measure of how person-centered and high-quality contraception counseling is.

Meurice cited some limitations of the study, including the small sample size, interpretation bias, lack of urban representation that would make the data more applicable to other large areas, and the inability to include people that could not access care.

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