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Original research article| Volume 100, ISSUE 3, P173-177, September 2019

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TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States

      Abstract

      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.

      Keywords

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      References

        • Jones R.K.
        • Jerman J.
        Abortion incidence and service availability in the United States, 2014.
        Perspect Sex Reprod Health. 2017; 49: 17-27
        • Cartwright A.F.
        • Karunaratne M.
        • Barr-Walker J.
        • Johns N.E.
        • Upadhyay U.D.
        Identifying National Availability of abortion care and distance from major US cities: systematic online search.
        J Med Internet Res. 2018; 20: e186
        • Jones R.K.
        • Upadhyay U.D.
        • Weitz T.A.
        At what cost? Payment for abortion care by U.S. women.
        Womens Health Issues. 2013; 23: e173-e178
        • Jerman J.
        • Jones R.K.
        Secondary measures of access to abortion services in the United States, 2011 and 2012: gestational age limits, cost, and harassment.
        Womens Health Issues. 2014; 24: e419-e424
      1. Planned Parenthood Releases New Educational Video on Telemedicine Abortion. (Accessed 7 December, 2018, at https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-releases-new-educational-video-on-telemedicine-abortion.)

        • Grindlay K.
        • Grossman D.
        Telemedicine provision of medical abortion in Alaska: through the provider's lens.
        J Telemed Telecare. 2017; 23: 680-685
        • Grossman D.
        • Grindlay K.
        Safety of medical abortion provided through telemedicine compared with in person.
        Obstet Gynecol. 2017; 130: 778-782
        • Raymond E.G.
        • Chong E.
        • Hyland P.
        Increasing access to abortion with telemedicine.
        JAMA Intern Med. 2016; 176: 585-586
        • Gomperts R.
        • van der Vleuten K.
        • Jelinska K.
        • da Costa C.V.
        • Gemzell-Danielsson K.
        • Kleiverda G.
        Provision of medical abortion using telemedicine in Brazil.
        Contraception. 2014; 89: 129-133
        • Gomperts R.
        • Petow S.A.
        • Jelinska K.
        • Steen L.
        • Gemzell-Danielsson K.
        • Kleiverda G.
        Regional differences in surgical intervention following medical termination of pregnancy provided by telemedicine.
        Acta Obstet Gynecol Scand. 2012; 91: 226-231
        • Gomperts R.
        • Kleiverda G.
        • Gemzell K.
        • Davies S.
        • Re Jelinska K.
        Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services.
        BJOG. 2008; 115: 1578-1579
        • Aiken A.R.A.
        • Digol I.
        • Trussell J.
        • Gomperts R.
        Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland.
        BMJ. 2017; 357j2011
        • Hyland P.
        • Raymond E.G.
        • Chong E.
        A direct-to-patient telemedicine abortion service in Australia: retrospective analysis of the first 18 months.
        Aust N Z J Obstet Gynaecol. 2018; 58: 335-340
        • Wiebe E.R.
        Use of telemedicine for providing medical abortion.
        Int J Gynaecol Obstet. 2014; 124: 177-178
        • Endler M.
        • Beets L.
        • Gemzell Danielsson K.
        • Gomperts R.
        Safety and acceptability of medical abortion through telemedicine after 9 weeks of gestation: a population-based cohort study.
        BJOG. 2019; 126: 609-618
        • Raymond E.G.
        • Blanchard K.
        • Blumenthal P.D.
        • et al.
        Sixteen years of overregulation: time to unburden Mifeprex.
        N Engl J Med. 2017; 376: 790-794
        • Chen M.J.
        • Creinin M.D.
        Mifepristone with buccal misoprostol for medical abortion: a systematic review.
        Obstet Gynecol. 2015; 126: 12-21
        • Upadhyay U.D.
        • Desai S.
        • Zlidar V.
        • et al.
        Incidence of emergency department visits and complications after abortion.
        Obstet Gynecol. 2015; 125: 175-183
        • Johns N.E.
        • Foster D.G.
        • Upadhyay U.D.
        Distance traveled for Medicaid-covered abortion care in California.
        BMC Health Serv Res. 2017; 17: 287
        • Upadhyay U.D.
        • Johns N.E.
        • Meckstroth K.R.
        • Kerns J.L.
        Distance traveled for an abortion and source of care after abortion.
        Obstet Gynecol. 2017; 130: 616-624
      2. Lawsuit challenges medically unjustified fda restrictions that push medication abortion out of reach. (Accessed November 13, 2018, at https://www.aclu.org/news/aclu-challenges-federal-restrictions-abortion-pill.)