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PURPOSE Established models of reproductive health service delivery were disrupted by the coronavirus disease 2019 pandemic. This study examines rapid innovation of remote abortion service operations across health care settings and describes the use of telehealth consultations with medications delivered directly to patients. METHODSWe conducted semi-structured interviews with 21 clinical staff from 4 practice settings: family planning clinics, online medical services, and primary care practices-independent or within multispecialty health systems. Clinicians and administrators described their telehealth abortion services. Interviews were recorded, transcribed, and analyzed. Staff roles, policies, and procedures were compared across practice settings.RESULTS Across all practice settings, telehealth abortion services consisted of 5 operational steps: patient engagement, care consultations, payment, medication dispensing, and follow-up communication. Online services and independent primary care practices used asynchronous methods to determine eligibility and complete consultations, resulting in more efficient services (2-5 minutes), while family planning and health system clinics used synchronous video encounters requiring 10-30 minutes of clinician time. Family planning and health system primary care clinics mailed medications from clinic stock or internal pharmacies, while independent primary care practices and online services often used mailorder pharmacies. Online services offered patients asynchronous follow-up; other practice settings scheduled synchronous appointments.CONCLUSIONS Rapid innovations implemented in response to disrupted in-person reproductive health care included remote medication abortion services with telehealth assessment/follow-up and mailed medications. Though consistent operational steps were identified across health care settings, variation allowed for adaptation of services to individual sites. Understanding remote abortion service operations may facilitate dissemination of a range of patient-centered reproductive health services.

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Purpose: To examine urban, inner-city female patients' acceptability of the provision of early abortion services by their family physician in the family medicine clinic (FMC).Methods: We administered a survey with open-and closed-ended questions to a convenience sample of English-or Spanish-speaking female patients aged 18 to 45 recruited from a FMC in the Bronx, New York. Responses were analyzed using quantitative and qualitative methods.Results: One hundred forty-eight women completed the survey. The majority of respondents stated the FMC should offer abortion services. Seventy percent agreed their clinic should provide medication abortion, and 47% agreed their clinic should provide suction abortion. Of those who would personally consider an abortion, 73% responded that they would prefer to have it done by their family physician in the FMC, whereas 22% would prefer it at a freestanding, high-volume abortion clinic, and 5% had no preference.Conclusions: The majority of patients surveyed accepted the integration of abortion services into our FMC setting, and would choose to have an early abortion at their FMC. Increasing options for abortion provision within our FMC was acceptable to the majority of our sample. 2,3 most FPs do not routinely provide early abortion. Patients must therefore seek abortion services from unfamiliar providers, disrupting the "continuity of care" philosophy that is fundamental to the family medicine model. Althoguh several FPs and family medicine residency programs in the United States offer early abortions in their offices, 3-5 patient preferences for receiving early abortion services within primary care are not documented.Our main study objective was to determine whether women of reproductive age in an urban, inner-city family medicine clinic (FMC) would accept abortion being offered in the FMC, and if available, would choose have an abortion with their FP in their FMC. This research letter reports on the first phase of a project that will ultimately involve multiple FM and abortion clinics. MethodsAn anonymous survey with open-and closed-ended questions was administered at a FMC located in a predominately minority, low-income neighborThis article was externally peer reviewed. Submitted

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