Information about abortion care largely omitted or buried on 80% of health systems’ patient-facing websites

Embargoed for release until 5:00 p.m. ET on Monday 16 October 2023
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
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1. Information about abortion care largely omitted or buried on 80% of health systems’ patient-facing websites

Lack of disclosure may contribute to stigma surrounding the procedure

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1389  

URL goes live when the embargo lifts 

A study of health systems’ websites found that despite being a routine procedure at many hospitals, abortion is not mentioned by almost 80 percent of health system websites. The research report is published in Annals of Internal Medicine.  

Patients often rely on online resources to learn about medications and procedures, including abortion. Online searches for abortion services are becoming more common after the Dobbs Supreme Court decision. Patient-oriented webpages may play an important role in patients locating abortion providers, learning about the procedure, and scheduling care. However, it is unknown whether hospitals and their health systems offer these online resources.

Researchers from University of Pennsylvania Perelman School of Medicine and Harvard Medical School studied websites of 222 U.S. hospitals in states without extreme abortion bans, including those with specialized abortion training programs, to measure how often they offer information about abortion and its provision at their facilities compared with colonoscopy, another common ambulatory procedure performed in both outpatient offices and hospitals. They found that 79.4 percent of patient-facing websites did not mention abortion, compared with 11.1 percent for colonoscopy. When the websites did mention abortion services, the information was found a mean of 0.5 pages lower in search engine results. The authors also report that for websites offering information about abortion, 89.8 percent omitted patient instructions for pre- or postprocedural care, compared with 42.2 percent of websites offering information about colonoscopy. According to the authors, their findings bring evidence to recent claims that hospitals have treated abortion care differently from other essential procedures, contributing to stigma surrounding abortion.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Ari B. Friedman, MD, PhD, please contact Ari Friedman at Ari.Friedman@pennmedicine.upenn.edu.

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2. Implementation of routine opioid use disorder screening fails to significantly boost new diagnosis rates

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1369

URL goes live when the embargo lifts 
In a brief research report, authors from University of Washington report that screening for opioid use disorder (OUD) in a primary care setting did not significantly boost the percentage of new diagnoses. Screening sensitivity could be a contributing factor and the authors suggest that addressing stigma may increase the sensitivity of the screening instrument.  The report is published in Annals of Internal Medicine.

Integrating care for common mental health disorders into primary care through screening and treatment has proved to be highly effective and is now a widespread practice. However, substance

use disorders often go unrecognized in primary care. Screening may be an effective approach to increase identification of OUD, and has been recommended by the USPSTF as it is for depression, anxiety, and alcohol use disorder.

Researchers analyzed data from 20 primary care clinics screening 167,710 patients for OUD to compare the percentage of patients who were newly diagnosed with OUD before and after implementation of the universal screening initiative. They found that only 0.11 percent of those screened had a new OUD diagnosis, only 0.03 percentage points more than before universal screening. Initial screening efforts occurred during the COVID-19 pandemic, but the authors note that anecdotal evidence suggests that post-pandemic screening was no more effective. They highlight that these findings may be influenced by multiple factors, including lower true prevalence of OUD, greater stigma (resulting in lower screener sensitivity than has been observed in psychometric studies), and/or greater delays in follow-up diagnostic assessments. The authors suggest that to address OUD in their communities, clinics may want to conduct outreach activities and publicize their commitment to accepting new patients seeking care for OUD.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author John C. Fortney, PhD please contact Chris Talbott at talbottc@uw.edu.

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3. Telemedicine visits comparable to in-person visits for addressing most patient clinical concern areas in primary care

Overall, differences in treatment and follow-up were small, but varied by specific clinical condition

Abstract: https://www.acpjournals.org/doi/10.7326/M23-1335 

URL goes live when the embargo lifts

A study of more than 1 million adults found that in primary care, telemedicine visits were comparable to in-person visits for addressing most patient clinical concern areas. Telemedicine visits resulted in lower treatment rates and higher rates of follow-up health care use compared with in-person office visits, but these differences were small and varied by clinical condition. The findings are published in Annals of Internal Medicine.

While telemedicine use expanded greatly during the COVID-19 pandemic, driven primarily by social

distancing efforts, longer-term use of telemedicine can continue to offer patients a convenient option and expand access to primary care. However, beyond initial pandemic-related telemedicine, there

is limited evidence for whether longer-term use of telemedicine visits in clinical practice adequately addresses patients’ needs, increases the likelihood of subsequent follow-up visits, or is more likely to be followed by a serious health event requiring an emergency department visit or hospital stay.

Researchers from Kaiser Permanente Division of Research conducted a retrospective study based on administrative and electronic health record data of 1,589,014 adult patients between April and December 2021 to compare treatment and follow-up visits (office, emergency department, hospitalization) between primary care video or telephone telemedicine and in-person office visits. The data showed that about half of all primary care visits within the study were telemedicine visits and medications were prescribed during 46.8 percent of in-person visits, 38.4 percent of video visits, and 34.6 percent of telephone visits. Only 1.3 percent of in-person visits had a follow-up appointment within 7 days of the initial appointment, while 6.2 percent of video visits and 7.6 percent of telephone visits had a follow-up appointment. Differences in follow-up office visits varied by clinical area and were largest after index office versus telephone visits for acute pain conditions and smallest after office versus telephone visits for mental health. Overall, the rates of follow-up emergency department visit and hospitalizations were low, and differences between in-person visits and telemedicine visits were small.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Mary Reed, DrPH, please contact Alex Yellin at Alex.yellin@mboothhealth.com.

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Also in this issue:

Regulatory Review Duration and Differences in Submission Times of Drugs in the United States and Europe, 2011 to 2020

Kerstin N. Vokinger, MD, JD, PhD*; Miquel Serra-Burriel, MSc, PhD*; Camille E.G. Glaus, JD, BSc; Ulrich-Peter Rohr, MD; Thomas J. Hwang, MD; Simon Dalla Torre di Sanguinetto, PhD; and Aaron S. Kesselheim, MD, JD, MPH

Medicine and Public Issues

Abstract: https://www.acpjournals.org/doi/10.7326/M23-0623