title: Influence of clinician referral on Nebraska women's decision-to-abortion time.
abstract: OBJECTIVE
  To assess the association of clinician referral with decision-to-abortion time.
  
  
  METHODS
  We conducted a cross-sectional survey of women seeking abortion at all three Nebraska abortion clinics. We defined referral as direct (information for an abortion clinic), inappropriate (information for a clinic that does not provide abortions) or no referral. Women reported when they recognized their pregnancy, decided to seek abortion and contacted a clinician. The primary outcome - decision-to-abortion time - was time from certain decision to abortion. We used multivariate linear regression analysis, controlling for potential confounders.
  
  
  RESULTS
  Participants (n=356) were a mean of 26.8±5.3years old, primarily white (62%), unmarried (88%) and urban (87%), with a mean gestational duration of 8(2/7)weeks (S.D.±20days). Forty-six percent (164) had contacted a clinician and 30% (104) had discussed abortion with one before their abortion. Of those, 30% received a direct referral, 6% received an inappropriate referral and 64% received no referral. Decision-to-abortion time did not vary by referral type [mean difference compared with direct referral: inappropriate referral, 1.1days, 95% confidence interval (CI) -13.4 to 15.6, p=.88; no referral, -0.4days, 95% CI -7.0 to 6.3]. The most common reasons cited for delay in obtaining an abortion were an inability to get an earlier appointment (105/263, 40%) and time needed to raise money to pay for the abortion (73/263, 28%).
  
  
  CONCLUSIONS
  While neither occurrence of referral nor type was associated with decision-to-abortion times, women in Nebraska continue to face barriers to timely abortion care.
  
  
  CONCLUSIONS
  Additional research is needed to explore whether quality clinician referral improves abortion access and whether increased resources should be dedicated to improving referral patterns.
authors.affiliation: Bixby Center for Global Reproductive Health, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: valerie.french@ucsf.edu.
authors.forename: Valerie
authors.initials: V
authors.lastname: French
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA; Center for Reducing Health Disparities, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: renaisa.anthony@unmc.edu.
authors.forename: Renaisa
authors.initials: R
authors.lastname: Anthony
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: chelsea.souder@gmail.com.
authors.forename: Chelsea
authors.initials: C
authors.lastname: Souder
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA. Electronic address: christine.geistkemper@gmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Geistkemper
authors.affiliation: Bixby Center for Global Reproductive Health, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: edrey@ucsf.edu.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Drey
authors.affiliation: Bixby Center for Global Reproductive Health, San Francisco, CA, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. Electronic address: jody.steinauer@ucsf.edu.
authors.forename: Jody
authors.initials: J
authors.lastname: Steinauer
mesh_terms: D000028:Abortion, Induced / Q000191:economics / Q000706:statistics & numerical data*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D009329:Nebraska; D011247:Pregnancy; D012017:Referral and Consultation; D013997:Time Factors
keywords: Abortion; Abortion referral; Access; Delay; Referral