O03Safety and effectiveness of synchronous and asynchronous telehealth medication abortion provided by us virtual clinics

Upadhyay, UD; Koenig, LR; Ko, J; Valladares, E; Meckstroth, K; Biggs, M. Antonia

doi:10.1016/j.contraception.2022.09.008

Cited by 4 publications

(5 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 Another study of telemedicine abortion up to 8 weeks gestation showed a 97.7% success rate, with only 0.25% of these sustaining serious adverse events, 0.16% requiring treatment for an ectopic pregnancy, and 1.3% involving a subsequent emergency department visit. 35 These data support the safety of telemedicine abortion, with outcomes similar to those of in-person medication abortion care. 30 Unlike telemedicine abortion, individuals who choose self-managed abortions source their own medications or supplements, including but not limited to mifepristone and misoprostol, without a provider.…”

Section: Medication Abortionmentioning

confidence: 54%

“…In early 2022 – prior to Dobbs – telemedicine medication abortions accounted for 4%–6% of abortions in the US; as of September 2023, telemedicine medication abortion accounted for 16%–17% of all US abortions, consistent with expected increases in volume due to mounting abortion restrictions 34 . In the telemedicine medication abortion model, patients communicate with a provider via video visit or an asynchronous platform, and receive mifepristone and misoprostol through the mail 35 . One study of 4584 people in the US who received a medication abortion with mifepristone and misoprostol by mail at up to 10 weeks gestation had a 96.4% success rate and only 1% required treatment for a serious adverse event 36 .…”

Section: Discussionmentioning

confidence: 99%

“…One study of 4584 people in the US who received a medication abortion with mifepristone and misoprostol by mail at up to 10 weeks gestation had a 96.4% success rate and only 1% required treatment for a serious adverse event 36 . Another study of telemedicine abortion up to 8 weeks gestation showed a 97.7% success rate, with only 0.25% of these sustaining serious adverse events, 0.16% requiring treatment for an ectopic pregnancy, and 1.3% involving a subsequent emergency department visit 35 . These data support the safety of telemedicine abortion, with outcomes similar to those of in‐person medication abortion care 30 .…”

Section: Discussionmentioning

confidence: 99%

“…34 In the telemedicine medication abortion model, patients communicate with a provider via video visit or an asynchronous platform, and receive mifepristone and misoprostol through the mail. 35 One study of 4584 people in the US who received a medication abortion with mifepristone and misoprostol by mail at up to 10 weeks gestation had a 96.4% success rate and only 1% required treatment for a serious adverse event. 36 Another study of telemedicine abortion up to 8 weeks gestation showed a 97.7% success rate, with only 0.25% of these sustaining serious adverse events, 0.16% requiring treatment for an ectopic pregnancy, and 1.3% involving a subsequent emergency department visit.…”

Section: Medication Abortionmentioning

confidence: 99%

See 3 more Smart Citations

Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers

Starosta,

Harris,

Gariepy

et al. 2024

Perspect Sexual Reproductive

View full text Add to dashboard Cite

BackgroundRecent legal changes have led to mounting abortion restrictions in the United States (US), disproportionately impacting adolescents, who already face multifaceted barriers to abortion care. Informed by the framework of reproductive justice, adolescents who become pregnant deserve comprehensive, unbiased, and non‐judgmental pregnancy options counseling, inclusive of all choices for pregnancy continuation and termination. Pediatric primary care providers are at the front lines of caring for adolescent patients' reproductive health needs and frequently diagnose pregnancy, provide pregnancy options counseling, and assist patients in accessing abortion care. They are uniquely poised to provide this care given their trusted, ongoing relationships with adolescent patients and their families, and their values of deep respect for adolescents' individuality and autonomy.MethodsIn this commentary, we aim to describe the medical and legal landscape of adolescent abortion access in the US and provide recommendations to support pediatric primary care providers' involvement in abortion care. We focus on medication abortion, as the provision of medication abortion has the potential to encompass a broad group of clinicians, including pediatric primary care providers.ResultsWe discuss the importance of providing options counseling to adolescents within the reproductive justice framework, improving abortion education for pediatric providers, and expanding access to abortion care by supporting providers at an institutional level if they opt to provide medication abortions.ConclusionIn light of the current legal landscape, the role of pediatric primary care providers in ensuring adolescent access to abortion care is ever more critical. Although many pediatric and adolescent providers already provide this important care, we, a team of obstetricians/gynecologists and adolescent medicine physicians, echo prior calls for improved training and institutional support for pediatric providers to counsel about and provide abortion‐related care. We hope that highlighting the role of pediatric providers in this sphere will help center the needs of adolescent patients and help them fulfill their family planning goals.

show abstract

Section: Medication Abortionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Medication Abortionmentioning

confidence: 99%

See 2 more Smart Citations

Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers

Starosta,

Harris,

Gariepy

et al. 2024

Perspect Sexual Reproductive

View full text Add to dashboard Cite

show abstract

“…Another US study found that medication abortion with mifepristone dispensed from a brick-and-mortar pharmacy was effective and acceptable to patients with a low prevalence of AEs . Other US studies of medication abortion with telehealth evaluation for eligibility and medications mailed either by the clinician or using a mail-order pharmacy similarly have found these models to be effective (estimates of complete abortion range from 93% to 99%), acceptable to patients (satisfaction ranges from 96% to 100%), and safe (serious AEs range from 0% to 1%) . This body of research supports the FDA decision in 2021 to permanently remove the in-person dispensing requirement for mifepristone.…”

Section: Discussionmentioning

confidence: 96%

Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening

Grossman,

Raifman,

Morris

et al. 2024

JAMA Intern Med

View full text Add to dashboard Cite

ImportanceBefore 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.ObjectiveTo estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.Design, Setting, and ParticipantsThis prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days’ gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023.InterventionMifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.Main Outcomes and MeasuresProportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.ResultsClinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing.Conclusions and RelevanceThe findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

show abstract

Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review

Koenig,

Ko,

Upadhyay

2024

J Med Internet Res

View full text Add to dashboard Cite

Background Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women’s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic’s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available.

show abstract

O03Safety and effectiveness of synchronous and asynchronous telehealth medication abortion provided by us virtual clinics

Cited by 4 publications

References 0 publications

Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers

Medication abortion for adolescents in the United States: Strengthening the role of pediatric primary care providers

Mail-Order Pharmacy Dispensing of Mifepristone for Medication Abortion After In-Person Screening

Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review

Contact Info

Product

Resources

About