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.

Introduction:To overcome obstacles to delivering medication abortion services during the COVID-19 pandemic, clinics and providers implemented new medication abortion service models not requiring in-person care. This study identifies organizational factors that promoted successful implementation of telehealth and adoption of "no test" medication abortion protocols. Methods:We conducted 21 semi-structured, in-depth interviews with healthcare providers and clinic administrators implementing clinician-supported telehealth abortion during the COVID pandemic. We selected 15 clinical sites to represent four different practice settings: independent primary care practices, online medical services, specialty family planning clinics, and primary care clinics within multispecialty health systems. The Consolidated Framework for Implementation Research (CFIR) guided our thematic analysis.Results: Successful implementation of telehealth abortion included access to formal and informal inter-organizational networks, including professional organizations and informal mentorship relationships with innovators in the field; organizational readiness for implementation, such as having clinic resources available for telehealth services like functional electronic health records and options for easy-to-use virtual patient-provider interactions; and motivated and effective clinic champions. Conclusions:In response to the need to offer remote clinical services, four different practice settings types leveraged key operational factors to facilitate successful implementation of telehealth abortion. Information from this study can inform implementation strategies to support the dissemination and adoption of this model.Implications-Examples of successfully implemented telehealth medication abortion services provide a framework that can be used to inform and implement similar patient-centered telehealth models in diverse practice settings.

No abstract

Context: Currently, less than 5% of family medicine practices offer first-trimester abortion services, which means that most patients must seek services at specialty family planning facilities. Since abortion is often excluded from insurance coverage, patients pay up to $800 out-of-pocket. Medication abortion via telehealth is much cheaper ($150-$400). Still, many patients cannot afford this amount. To expand affordability, Aid Access -an asynchronous clinician-supported online abortion service -implemented a sliding-scale payment option that allows patients who ask for a discounted rate to choose a payment amount between $0 and $150 or use Medicaid if located in New York (NY). With the availability of telemedicine, more family medicine providers are starting to offer medication abortion services. It is important to understand the financial needs of patients seeking abortion so family physicians can implement payment options that increase access to these essential services. Objective: Analyze percent of patients who utilized sliding scale payment option including Medicaid in NY, along with how much was paid. Study Design: Retrospective chart review. Setting or Dataset: De-identified data from Aid Access patients served by family physicians in Washington (WA), New Jersey (NJ), and NY, including payment information. Population Studied: Patients who received mifepristone, misoprostol medication abortion through Aid Access in WA, NJ, and NY between April and November 2020 (n=504). Main and Secondary Outcome Measures: (1) Percent of patients who used the sliding scale payment option; (2)