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Using telemedicine to reduce the cost of medical abortion to patients and extend the reach of providers to rural areas and across state lines

Published
May 10th, 2019
Type
Staff Publication
Topic
Medical Abortion
Authors
Chong, E.

Introduction: In May 2016, we launched the TelAbortion Project, which enables women in participating states to obtain medical abortion from home by telemedicine and mail without coming in person to an abortion facility. We will present updated service statistics and discuss the implications of this model for improving abortion access in the U.S.

Methods: To obtain a TelAbortion, a woman contacts a project site and receives counseling and instructions by videoconferencing. She has screening tests at facilities close to her. If she is eligible, the site mails or prescribes a standard medical abortion regimen. She obtains follow-up tests and speaks with TelAbortion staff to confirm complete abortion. Women or their insurance carries pay for all services received outside project sites, and since late 2017, also for services obtained directly from the project. TelAbortion is currently implemented by providers in Hawaii, Oregon, and Maine, some of whom are also licensed to practice in New York and Washington.

Results: Through December 2018, TelAbortion clinicians provided treatment to 250 women. Of women in the continental U.S., 39% lived more than 100 miles from the treating facility, and 27% received treatment across state lines. In Hawaii, 65% of women were treated across islands. Abortion outcomes did not vary by distance or by cross-state or cross-island dispensing. Of 36 women who paid out-of-pocket for the abortion itself. 52% used or planned to use Medicaid or private insurance to cover the costs of the screening tests. We are initiating TelAbortion in Colorado, New Mexico, and Georgia soon and will report results from those states at the meeting.

Conclusion: Direct-to-patient telemedicine is safe and acceptable for providing abortion over long distances and may particularly benefit women with limited ability to access the service locally. Cross-state prescribing my be a valuable strategy for scaling up this type of service quickly. Separating the screening and follow up testing from the abortion itself can allow women without coverage for abortion to use insurance for part of their care, such that the cost is comparable and in some cases less expensive than paying out of pocket for an in-clinic medical abortion.

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