Abortion care gets high marks from patients

The first comprehensive look at the quality of abortion care in the United States shows high levels of satisfaction from the perspective of women who have received such services.1

Based on interviews with more than 2,200 women who have had abortions, 60% rated their care as "excellent," with another 38% registering level of services as "very good" or "good." The survey was conducted for the Kaiser Family Foundation of Menlo Park, CA, by The Picker Institute, a Boston-based health care quality assessment and improvement research organization affiliated with the Beth Israel Deaconess Medical Center Corp.

Abortions performed in the United States are among the safest medical procedures.2 Though many clinical studies have been conducted to document the safety and efficacy of abortion procedures, no large-scale studies have examined patients’ experience with abortion.

"Studies of patient satisfaction have largely ignored a very common procedure among women of reproductive age, and we thought it was time to find out about the quality of abortion through the eyes of women experiencing them," says Tina Hoff, director of Kaiser Family Foundation’s public health information and communications.

The public, in general, is unaware about the quality of U.S. abortion services, states Phillip Stubblefield, MD, professor and chairman of OB/GYN at Boston University School of Medi cine and director of OB/GYN at Boston Medical Center. Stubblefield served as moderator for a discussion of current levels of abortion care services at a news briefing sponsored by Kaiser Family Foundation and the National Press Foundation in Washington, DC.

"Women typically, if they need an abortion, get one and then they don’t want to talk about it anymore," Stubblefield observes. "It is nice to have some real information and have it get into the news media, magazines, and journals that people will see."

Look at the study

Twelve abortion clinics from different areas of the United States were chosen to reflect the characteristics of abortion clinics nationwide. Annual procedure volume ranged at the sites from 1,500 at one facility to 8,000 at the largest clinic. Four of the clinics were nonprofit, while eight were for-profit. Six were freestanding, three were part of multi-clinic provider groups, and three were affiliates of Planned Parenthood Federation of America in New York City.

Interviews were conducted between July and October of 1998 with women who were contacted three to four weeks following their abortions. Site visits were made to each facility to map the process of care, examine existing patient feedback mechanisms, and conduct focus group research with patients and providers.

In addition to tabulating results regarding patients’ perceptions of abortion care, researchers also compared those results with perspectives collected from a national database of female ambulatory surgery patients.

The measure that most influenced patients’ overall rating of quality of care was the adequacy of the information they received from the clinic staff about the procedure and what to expect physically and emotionally following the abortion. A total of 98% of women participating in the survey said the abortion procedure was explained to them, and 99% reported that the information was clear and understandable. In contrast, patients in other satisfaction surveys conducted by The Picker Institute involving other health care services consistently report wanting more information than they received.

Overall attention to privacy was rated by 94% as "excellent," "very good," or "good" by women receiving abortions. Staff interactions also earned high marks, with 88% of women reporting they were treated with "a lot of respect and dignity" and 78% noting they had "a lot of confidence and trust" in clinic staff. A total of 96% of those receiving abortion care say they would recommend their abortion provider to a friend or family member, according to the study.

Though earning high marks from most patients, responses indicate that clinics could improve care by:

• providing more privacy in the waiting area;

• offering more post-procedure telephone help;

• giving more information when patients call to make an appointment;

• dispensing more pain relief;

• furnishing more intensive care in the recovery area.

Keeping standards high

Results of the survey are not surprising, says Bernard Smith, MD, who serves as the chairman of the Washington, DC-based National Abortion Federation committee on quality improvement. While it is difficult to make a one-to-one correlation with perceptions of care with the outcomes and medical care data collected for quality assurance purposes, abortion providers have known that they have done a good job in providing quality patient care, notes Smith.

Smith, a Milwaukee abortion provider, says he will apply the survey’s results to his own facility in enhancing the privacy of patients in the recovery area and continuing to ensure that confidentiality is observed in all aspects of care. "I think most, if not all, clinics handle that issue [confidentiality] quite well," he notes. "I know we have in place certain steps and protocol to assure it."

References

1. Kaiser Family Foundation. From the Patient’s Perspective: Quality of Abortion Care. Menlo Park, CA; 1999.

2. Council on Scientific Affairs, American Medical Association. Induced termination of pregnancy before and after Roe v Wade. Trends in the mortality and morbidity of women. JAMA 1992; 268:3,231-3,239.