Telehealth and Reproductive Health Equity

远程医疗和生殖健康公平

基本信息

批准号：
10737445
负责人：
Ushma Desai Upadhyay
金额：
$ 54.39万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-20 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10737445
关键词：
Address Affect Area Biometry COVID-19 pandemic Caring Censuses Clinic Clinic Visits Clinical Colorado Communication Consultations Contraceptive methods Contracts Devices Electronics Eligibility Determination Enrollment Ensure Equity Face Funding Geography Goals Health Health Personnel Health Services Healthcare Immigrant Induced Abortion Inequity Institutional Racism Insurance Intake Internet Language Learning Legal Legal Status Low Income Population Mail Order Market Research Methods Mifepristone Misoprostol Outcome Patients Persons Pharmaceutical Preparations Pharmacy facility Policies Population Pregnancy Pregnancy Outcome Primary Health Care Privacy Privatization Progesterone Provider Reproductive Health Research Role Safety Schools Secure Services Site Stigmatization Surveys Technology Telephone Text Time Translations Uterus Virginia Visit Women&apos s Health Work abortion access disparities asynchronous communication cohort cost design digital disparity reduction experience experimental study follow-up geographic disparity health care availability health care disparity health care service health equity health inequalities health organization indexing innovation interest literacy marginalization marginalized population people of color policy recommendation preference programs recruit service delivery social social vulnerability structural determinants telehealth

项目摘要

PROJECT SUMMARY Historically marginalized populations such as people of color, low-income people, and immigrant populations disproportionately face barriers to reproductive healthcare. Telehealth options for reproductive health care services are growing and may address some of the distance and cost barriers to access. Research on telehealth for primary care suggests that it may bridge geographic disparities, allow for easier language translations, feel safer and more private for immigrant populations, be less expensive, and require less time off work or school. Conversely, telehealth services could exacerbate inequities if patients lack technology, digital literacy, and reliable internet coverage. Our long-term goal is to reduce disparities in healthcare access and to optimize telehealth for groups historically marginalized from healthcare including people of color, low-income people, and immigrants. The goal of this research is to determine whether telehealth provides patients with more timely and affordable reproductive healthcare, whether telehealth reaches people in areas with greater health inequities, and which attributes of telehealth patients prefer. The Telehealth and Reproductive Health Equity study will enroll 2,000 patients seeking reproductive health care. One cohort will comprise 1,000 patients seeking telehealth or in-person services through the clinic sites. A second cohort of 1,000 patients searching for a reproductive healthcare provider online will be recruited using Google Ads. In Aim 1 we will determine the ways in which telehealth services affect timing, costs, and follow-up care relative to in-person care. We will also compare rates of unplanned in-person care between telehealth and in-person groups. The cohorts recruited from clinics and via Google Ads will be analyzed separately. In Aim 2 we will conduct a geospatial analysis of patient census block groups or tracts to determine whether compared to patients using in-person care for abortion care, patients using telehealth reside in areas with greater health inequities. We will compare the telehealth and in-person groups using four social vulnerability indices. In Aim 3 we will determine preferences in and barriers to telehealth for reproductive healthcare, focusing on historically marginalized populations. We will use two innovative methods traditionally used for market research, the discrete choice experiment and maximum difference analysis. This research addresses substantial and increasing disparities in access to healthcare in historically marginalized groups. The results of the proposed research will provide clear guidance on how health care providers can design telehealth services so that they are accessible and attractive to people of color, low-income people, and immigrants. Our results will contribute to digital inclusion and increased health access and will be applicable to all areas of healthcare.

项目概要历史上被边缘化的人群，如有色人种、低收入人群和移民人口在生殖保健方面面临着不成比例的障碍。远程医疗选项生殖保健服务正在增长，可能会解决一些距离和成本障碍访问。对初级保健远程医疗的研究表明，它可以弥合地理差异，允许更容易的语言翻译，让移民群体感觉更安全、更私密，减少价格昂贵，并且需要更少的下班或上学时间。相反，远程医疗服务可能会加剧如果患者缺乏技术、数字素养和可靠的互联网覆盖，就会出现不平等。我们的长期目标是为了减少医疗保健获取方面的差异并优化历史上群体的远程医疗被医疗保健边缘化的人，包括有色人种、低收入人群和移民。目标是这项研究旨在确定远程医疗是否为患者提供更及时且负担得起的服务生殖保健，远程医疗是否覆盖健康不平等程度更大地区的人们，以及远程医疗患者更喜欢哪些属性。远程医疗和生殖健康公平研究将招募 2,000 名寻求医疗保健服务的患者生殖保健。一组将包括 1,000 名寻求远程医疗或面对面医疗的患者通过诊所站点提供服务。第二组由 1,000 名患者组成，寻找生育能力将使用 Google Ads 招募在线医疗保健提供者。在目标 1 中，我们将确定以下方法：与现场护理相比，哪些远程医疗服务会影响时间、成本和后续护理。我们也会比较远程医疗和面对面护理组之间计划外的面对面护理的比率。队列从诊所和通过 Google Ads 招募的人员将分别进行分析。在目标 2 中，我们将进行对患者人口普查区块组或区域进行地理空间分析，以确定是否与患者进行比较使用现场护理进行堕胎护理，使用远程医疗的患者居住在健康状况较好的地区不平等。我们将使用四个社会脆弱性指数来比较远程医疗和现场医疗组。在目标 3 中，我们将确定生殖保健远程医疗的偏好和障碍，重点关注历史上被边缘化的人群。我们将使用两种传统上使用的创新方法对于市场研究，离散选择实验和最大差异分析。这项研究解决了在获得医疗保健方面存在的巨大且日益扩大的差距历史上被边缘化的群体。拟议研究的结果将为以下方面提供明确的指导：医疗保健提供者如何设计远程医疗服务，以便人们可以获得并有吸引力有色人种、低收入人群和移民。我们的成果将有助于数字包容性和增加医疗保健的可及性，并将适用于医疗保健的所有领域。