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Jill Durocher

TelAbortion: Evaluation of a Direct to Patient Telemedicine Abortion Service in the United States

Published
June 3rd, 2019
Type
Publication
Topic
Medical Abortion
Authors
Raymond, E., Chong, E., Winikoff, B., Platais, I., Mary, M., Lotarevich, T., Castillo, P.W., Kaneshiro, B., Tschann, T., Fontanilla, T., Baldwin, M., Schnyer, A., Coplon, L., Mathieu, N., Bednarek, P., Keady, M.. Priegue, E.

This article was the recipient of a 2020 Daniel Mishell Outstanding Article award.
Contraception; June 03, 2019; Vol. 100(3):173-177; doi: https://doi.org/10.1016/j.contraception.2019.05.013

Objectives: To evaluate the safety, feasibility, and acceptability of a direct-to-patient telemedicine service that enabled people to obtain medical abortion without visiting an abortion provider in person.

Study design: We offered the service in five states. Each participant had a videoconference with a study clinician and had pre-treatment laboratory tests and ultrasound at facilities of her choice. If the participant was eligible for medical abortion, the clinician sent a package containing mifepristone, misoprostol, and instructions to her by mail. After taking the medications, the participant obtained follow-up tests and had a follow-up consultation with the clinician by telephone or videoconference to evaluate abortion completeness. The analysis was descriptive.

Results: Over 32 months, we conducted 433 study screenings and shipped 248 packages. The median interval between screening and mailing was 7 days (91st percentile 17 days), and no participant took the mifepristone at ≫71 days of gestation. We ascertained abortion outcomes of 190/248 package recipients (77%): 177/190 (93%) had complete abortion without a procedure. Of the 217/248 package recipients who provided meaningful follow-up data (88%), one was hospitalized for postoperative seizure and another for excessive bleeding, and 27 had other unscheduled clinical encounters, 12 of which resulted in no treatment. A total of 159/248 participants who received packages (64%) completed satisfaction questionnaires at study exit; all were satisfied with the service.

Conclusions: This direct-to-patient telemedicine abortion service was safe, effective, efficient, and satisfactory. The model has the potential to increase abortion access by enhancing the reach of providers and by offering people a new option for obtaining care conveniently and privately.

Implications: Provision of medical abortion by direct-to-patient telemedicine and mail has the potential to increase abortion access by increasing the reach of providers and by offering people the option of obtaining abortion care without an in-person visit to an abortion provider.