Abstract
Objective(s)
Telemedicine for medication abortion (teleMAB) is safe and effective, yet little is
known about how its introduction affects service delivery. We assessed changes in
service delivery patterns 1 year after introducing teleMAB at Planned Parenthood in
2 U.S. states.
Study Design
Retrospective records analysis using electronic health record data from Planned Parenthood
health centers in Montana and Nevada from 2015 to 2018. We included all patients receiving
medication or aspiration abortion in the year before and after introducing site-to-site
teleMAB. Outcomes included: the proportion of medication abortions (vs. aspiration);
gestational age at abortion; time to appointment; and distance traveled. We compared
outcomes pre- and postimplementation using χ2, t tests, and Mann-Whitney U tests.
Results
We analyzed data for 3,038 abortions: 1,314 pre- and 1,724 postimplementation. In
Montana, the proportion of medication abortions increased postimplementation (60%
vs. 65%, p = 0.04). Mean gestational age was similar: 58 versus 57 days (p = 0.35). Mean time to appointment decreased (14 vs. 12 days, p < 0.0001), as did one-way distance traveled by patients (134 vs. 115 miles, p = 0.03). In Nevada, where Planned Parenthood only provided medication abortion, total
medication abortions increased (461 vs. 735). Mean gestational age remained stable
(51 vs. 51 days, p = 0.33), as did time to appointment (8 vs. 8 days, p = 0.76). Mean one-way distance traveled was 47 miles in the preperiod versus 34 miles
in the postperiod (p = 0.22).
Conclusion(s)
Medication abortion increased after the introduction of telemedicine in both states,
though we cannot account for abortions performed by other providers. Telemedicine
has the potential to improve access to medication abortion.
Implications
Telemedicine has the potential to improve or maintain access to medication abortion
and should be taken to scale where feasible. Continued efforts are needed to mitigate
or reverse policy restrictions on telemedicine for medication abortion.
Keywords
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Article info
Publication history
Published online: December 22, 2020
Accepted:
December 15,
2020
Received in revised form:
November 25,
2020
Received:
September 3,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
