Abstract
Objectives
To examine associations between factors associated with loss to follow-up and effectiveness
in the TelAbortion project, which provided medication abortion by direct-to-patient
telemedicine and mail in the United States.
Study design
The study population for this descriptive analysis included abortions among participants
enrolled in the TelAbortion study with data present in a web-based database tool from
November 2018 to September 2021 who were mailed a medication package. The analysis
included information on abortions across nine sites. In this analysis, we used generalized
estimating equations to examine factors associated with loss to follow-up and effectiveness.
Results
Of the 1831 abortions included in this analysis, 1553 (84.8%) were classified as having
complete follow-up and 278 (15.2%) were classified as lost to follow-up. In a multivariable
analysis, factors significantly associated with loss to follow-up included history
of medical abortion, education, gestational age, study site, and whether the TelAbortion
was performed pre- or post-COVID-19 onset (p < 0.05). The rate of treatment failure (i.e., abortions resulting in continuing pregnancy
or uterine evacuation) reported in this study was 5.1%. The only covariate associated
with both loss to follow-up and treatment failure was higher gestational age. However,
using gestational age to impute missing abortion outcomes did not substantially change
the estimated failure rate.
Conclusions
Abortions that were lost to follow-up differed substantially from those with complete
follow-up, which could bias the effectiveness estimate. However, imputing outcomes
based on available and appropriate pretreatment data did not substantially affect
the estimate. This finding is encouraging, although it does not exclude the possibility
of bias due to unmeasured factors.
Implications
Significant differences between abortion cases with complete follow-up and those lost
to follow-up provide insights into abortion cases that may be at a higher risk for
being lost. The low treatment failure rate indicates that the telemedicine provision
of medication abortion is effective.
Keywords
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Article info
Publication history
Published online: February 23, 2023
Accepted:
February 19,
2023
Received in revised form:
February 15,
2023
Received:
August 23,
2022
Publication stage
In Press Corrected ProofFootnotes
☆Conflicts of interest: None.
☆☆Funding: This work was supported by the Tara Health Foundation, the Lisa and Douglas Goldman Fund, the David and Lucile Packard Foundation, and two anonymous donors. These donors had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
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