Information on early medical abortion for women using an audiovisual animation vs face‐to‐face consultation: A consortium randomized and quasi‐randomized trial

Boydell

Cameron

et al. 2021

BMJ Sex Reprod Health

Self Cite

BackgroundTelemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs).MethodsQualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically.ResultsWe present three themes from our qualitative analysis: (1) Selective use of ultrasound – the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues – in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation – telephone consultations were considered more focused than in-person consultations and formed only part of the overall ‘package’ of information provided to patients, supplemented by online and written information.ConclusionsACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.

Section: Discussionmentioning

confidence: 99%

A qualitative study of abortion care providers’ perspectives on telemedicine medical abortion provision in the context of COVID-19

Boydell

Cameron

et al. 2021

BMJ Sex Reprod Health

Self Cite

“…2 They were advised to visit the service website for more information on what to expect at the teleconsultation, including audiovisual resources. 12 Those aged less than 16 years were routinely offered an in-person appointment.…”

Section: The Telemedicine Modelmentioning

confidence: 99%

Telemedicine medical abortion at home under 12 weeks’ gestation: a prospective observational cohort study during the COVID-19 pandemic

Johnstone

McCabe

et al. 2021

BMJ Sex Reprod Health

Self Cite

108

BackgroundIn response to the COVID-19 pandemic, legislation and guidance were introduced in Scotland permitting medical abortion at home by telemedicine for pregnancies at less than 12 weeks’ gestation. Women had a telephone consultation with a clinician. Routine ultrasound was not performed. Medications and a low-sensitivity pregnancy test to confirm success of treatment were collected by or delivered to the woman, with telephone support provided as needed.MethodsA prospective cohort study of 663 women choosing medical abortion at home via the NHS Lothian telemedicine abortion service between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed 4 and 14 days following treatment. Regional hospital databases were reviewed to verify abortion outcomes and complications within 6 weeks. Outcome measures included efficacy, complications and acceptability.ResultsAlmost all (642/663, 98.2%) the women were under 10 weeks’ gestation. For 522/663 (78.7%) women, gestation was determined using last menstrual period alone. Some 650/663 (98%) women had a complete abortion, 5 (0.8%) an ongoing pregnancy and 4 (0.6%) an incomplete abortion. No one was treated inadvertently beyond 12 weeks’ gestation, but one woman was never pregnant. One woman who had a pre-abortion ultrasound was later managed as a caesarean scar ectopic. There were two cases of haemorrhage and no severe infections. Some 123 (18.5%) women sought advice by telephone for a concern related to the abortion and 56 (8.4%) then attended a clinic for review. Most (628, 95%) women rated their care as very or somewhat acceptable.ConclusionsThis model of telemedicine abortion without routine ultrasound is safe, and has high efficacy and high acceptability among women.

“…This is supplemented by written information (in the treatment pack) and audiovisual information available via a dedicated website. 10 If the person seeking abortion had a certain last menstrual period under 12 weeks previously and is without signs, symptoms or significant risk factors of ectopic pregnancy, an ultrasound is not required. 11 For those choosing medical abortion at home, the medications are later collected or delivered to them.…”

Section: Introductionmentioning

confidence: 99%

“…The NHS Lothian telemedicine model involves a telephone consultation with a clinician, during which information about the abortion process and post‐abortion contraception is provided and verbal consent for the procedure is obtained. This is supplemented by written information (in the treatment pack) and audiovisual information available via a dedicated website 10 . If the person seeking abortion had a certain last menstrual period under 12 weeks previously and is without signs, symptoms or significant risk factors of ectopic pregnancy, an ultrasound is not required 11 .…”

Section: Introductionmentioning

confidence: 99%

Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID‐19) pandemic: a qualitative evaluation

Boydell

Cameron

et al. 2021

BJOG

Self Cite

Objective To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision. Design Qualitative interview study. Setting Abortion service in one National Health Service health board in Scotland. Population or sample Twenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation. Methods Thematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach. Main outcome measures Women’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home. Results Novel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan. Conclusions This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service. Tweetable abstract #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.