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Contraception. 2019 Jun 4. pii: S0010-7824(19)30176-3. doi: 10.1016/j.contraception.2019.05.013. [Epub ahead of print]

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

Author information

1
Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: eraymond@gynuity.org.
2
Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: echong@gynuity.org.
3
Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: bwinikoff@gynuity.org.
4
Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: iplatais@gynuity.org.
5
Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: mtarnagada@gynuity.org.
6
Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: tlotarevich@gynuity.org.
7
Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA. Electronic address: pcastillo@guttmacher.org.
8
Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826. Electronic address: blissk@hawaii.edu.
9
Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826; Society of Family Planning, 225 South 17th Street, Suite 2709, Philadelphia, PA 19103-0046. Electronic address: mtschann@societyfp.org.
10
Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826. Electronic address: tianamf@hawaii.edu.
11
Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239. Electronic address: schaum@ohsu.edu.
12
Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239. Electronic address: schnyer@ohsu.edu.
13
Maine Family Planning, PO Box 587, Augusta, ME 04332. Electronic address: lcoplon@mainefamilyplanning.org.
14
Maine Family Planning, PO Box 587, Augusta, ME 04332. Electronic address: nmathieu@mainefamilyplanning.org.
15
Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239; Planned Parenthood Columbia Willamette, 3727 NE Martin Luther King Jr. Blvd, Portland, OR 97212. Electronic address: paula.bednarek@ppcw.org.
16
Planned Parenthood Columbia Willamette, 3727 NE Martin Luther King Jr. Blvd, Portland, OR 97212. Electronic address: meghan.keady@ppcw.org.
17
Choices Women's Medical Center, 147-32 Jamaica Ave, Jamaica, NY 11435. Electronic address: epriegue@choicesmedical.com.

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:

Mail; Medical abortion; Telemedicine; United States

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