Abstract
Objective
Describe the implementation of a preoperative telemedicine program at a Northern California
hospital-based center for abortion procedures requiring cervical preparation.
Study Design
We implemented a pilot program using telemedicine for preoperative visits for patients
needing cervical preparation prior to an abortion procedure from 12 to 18 weeks. We
required ultrasonography for gestational age documentation in addition to placental
localization in patients with a prior cesarean delivery. We prescribed misoprostol
for cervical preparation for patients undergoing the telemedicine preoperative visit;
in-person preoperative visits typically involve placement of osmotic dilators. Secondarily,
we surveyed patients who had telemedicine and in-person preoperative visits to compare
their preoperative experiences.
Results
Implementation required 8 months of multidisciplinary meetings. From March 2018 through
March 2019, we received 200 abortion referrals at 12 to 18 weeks gestation. Of these
200 patients, 119 did not meet telemedicine eligibility criteria, most commonly due
to inability to obtain required ultrasonography (n = 89 [75%]). Of the remaining 81 patients, 43 scheduled telemedicine visits of which
41 initiated and 38 (88%) completed the visits. Twenty-one (55%) telemedicine encounters
had no or minor technical difficulties. Thirty-one of 34 (91%) telemedicine and 91
of 108 (84%) in-person visit patients expressed high satisfaction with their preoperative
appointment (p = 0.4); none reported dissatisfaction. Patients chose the telemedicine visit primarily
for convenience and transportation concerns.
Conclusion
A multidisciplinary team is essential for the successful implementation of a preoperative
telemedicine program for procedural abortion care. Patients reported high satisfaction
and reduced logistical burdens with the telemedicine option.
Implications
Telemedicine preoperative visits for abortion procedures at 12 to 18 weeks gestation
may improve access to abortion care, reduce patient burdens, and provide an alternative
encounter option which may improve the patient experience.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Abortion incidence and service availability in the United States, 2014.Perspect Sex Reprod Health. 2017; 49: 17-27
- Distance traveled to obtain clinical abortion care in the United States and reasons for clinic choice.J Women's Health. 2019; 28: 1623-1631
- A systematic review of economic analyses of telehealth services using real time video communication.BMC Health Serv Res. 2010; 10: 233
- The use of telemedicine in surgical care: a systematic review.Acta Inform Med. 2018; 26: 201-206
- Development, implementation, and evaluation of a telemedicine preoperative evaluation initiative at a major academic center.Anesth Analg. 2020; 131: 1647-1656
- Telemedicine consultations in oral and maxillofacial surgery: a follow-up study.J Oral Maxillofac Surg. 2016; 74: 262-268
- Telemedicine consultations in oral and maxillofacial surgery.J Oral Maxillofac Surg. 1999; 57: 136-138
- Effectiveness and acceptability of medical abortion provided through telemedicine.Obstet Gynecol. 2011; 118: 296-303
- Reaching women where they are: eliminating the initial in-person medical abortion visit.Contraception. 2015; 92: 190-193
- Safety of medical abortion provided through telemedicine compared with in person.Obstet Gynecol. 2017; 130: 778-782
- Characteristics of patients having telemedicine versus in-person informed consent visits before abortion in Utah.Contraception. 2020; 101: 56-61
- Telemedicine for medical abortion: a systematic review.BJOG. 2019; 126: 1094-1102
- Family planning and abortion services in COVID-19 pandemic.Taiwan J Obstet Gynecol. 2020; 59: 808-811
- safe abortion in women's hands: autonomy and human rights approach to COVID-19 and beyond.Health Hum Rights. 2021; 23: 191-197
- The impact of COVID-19 on contraception and abortion care policy and practice: experiences from selected countries.BMJ Sex Reprod Health. 2020; 46: 241-243
- Definitions, measurement and indicator selection for quality of care in abortion.Contraception. 2019; 100: 354-359
- Factors associated with use of an online telemedicine service to access self-managed medical abortion in the US.JAMA Netw Open. 2021; 4e2111852
- Women's and provider's experiences with medical abortion provided through telemedicine: a qualitative study.Women's Health Issues. 2013; 23: 117-122
- At-home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations.BMJ Sex Reprod Health. 2020; 46: 172-176
- It was close enough, but it wasn’t close enough: a qualitative exploration of the impact of direct-to-patient telemedicine abortion on access to abortion care.Contraception. 2021; 104: 67-72
- Women’s experiences using telemedicine to attending abortion information visits in Utah: a qualitative study.Women’s Health Issues. 2019; 29: 407-413
- Spatial dimensions of telemedicine and abortion access: a qualitative study of women's experiences.Reprod Health. 2019; 16: 1-10
- Informed consent in refractive surgery: in-person vs telemedicine approach.Clin Ophthalmol. 2018; 12: 2459
- Telemedicine provides noninferior research informed consent for remote study enrollment: a randomized controlled trial.Acad Emerg Med. 2016; 23: 759-765
Article info
Publication history
Published online: June 21, 2022
Accepted:
June 3,
2022
Received in revised form:
May 24,
2022
Received:
November 30,
2021
Footnotes
Conflicts of interest: None.
Funding: This work was supported by the Society of Family Planning no. SFPRF18-04.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
