Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

Abstract

Objective To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.Design Cohort analysis.Setting The three main abortion providers.Population or sample Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.Methods Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.Main outcome measures Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.Results Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.Conclusions A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.

Why women choose at-home abortion via teleconsultation in France: drivers of telemedicine abortion during and beyond the COVID-19 pandemic

“…27 Examining some immediate impacts of telemedicine abortion provision in the UK, a recent study found that introduction of telemedicine for abortion care during the pandemic has reduced the waiting times for termination by 4.2 days and also that more abortions were provided at less than 6 weeks’ gestation with telemedicine. 28 Another study examining at-home abortion by telemedicine at less than 12 weeks’ gestation in Scotland during the pandemic suggests that abortion without routine ultrasound is safe, and has high efficacy and high acceptability among women. 29 Further research should examine the impact of telemedicine abortion provision on the French health system to better inform COVID-19 response and policymaking during and beyond the pandemic.…”

Factors Associated With Use of an Online Telemedicine Service to Access Self-managed Medical Abortion in the US

“…6 Second, there is increasing evidence that medication abortion provided without ultrasonography and with minimal oversight from health care professionals is safe and effective. 7,8 Since its approval, mifepristone has been subject to a risk evaluation management strategy (REMS), which restricts its use in ways not supported by evidence, including an in-person dispensing requirement. Health care professionals have called for the US Food and Drug Administration to remove the REMS and enable mifepristone to be obtained from pharmacies after remote consultation with a provider.…”

Safeguarding and telemedical abortion services

“…This allows healthcare professionals to deliver a service via telephone, video call and the internet. Since the introduction of the COVID-19 restrictions, 85% of abortion consultations are undertaken via telephone or video call in England 3. These conversations need to be conducted remotely in as safe a manner as possible, and additionally there needs to be the flexibility to provide a face-to-face appointment for those clients who may have difficulty accessing telemedicine or who do not have a private space in which to access a telephone or video call.…”