Effectiveness and Acceptability of Medical Abortion Provided Through Telemedicine

Grossman, Daniel MD; Grindlay, Kate MSPH; Buchacker, Todd RN; Lane, Kathleen; Blanchard, Kelly MSc

doi: 10.1097/AOG.0b013e318224d110
Original Research

OBJECTIVE: To estimate the effectiveness and acceptability of telemedicine provision of early medical abortion compared with provision with a face-to-face physician visit at a Planned Parenthood affiliate in Iowa.

METHODS: Between November 2008 and October 2009, we conducted a prospective cohort study of women obtaining medical abortion by telemedicine or face-to-face physician visits. We collected clinical data, and women completed a self-administered questionnaire at follow-up. We also compared the prevalence of reportable adverse events between the two service delivery models among all patients seen between July 2008 and October 2009.

RESULTS: Of 578 enrolled participants, follow-up data were obtained for 223 telemedicine patients and 226 face-to-face patients. The proportion with a successful abortion was 99% for telemedicine patients (95% confidence interval [CI] 96–100%) and 97% for face-to-face patients (95% CI 94–99%). Ninety-one percent of all participants were very satisfied with their abortion, although in multivariable analysis, telemedicine patients had a higher odds of saying they would recommend the service to a friend compared with face-to-face patients (odds ratio, 1.72; 95% CI 1.26–2.34). Twenty-five percent of telemedicine patients said they would have preferred being in the same room with the doctor. Younger age, less education, and nulliparity were significantly associated with preferring face-to-face communication. There was no significant difference in the prevalence of adverse events reported during the study period among telemedicine patients (n=1,172) (1.3%; 95% CI 0.8–2.1%) compared with face-to-face patients (n=2,384) (1.3%; 95% CI 0.9–1.8%) (82% power to detect difference of 1.3%).

CONCLUSION: Provision of medical abortion through telemedicine is effective and acceptability is high among women who choose this model.

LEVEL OF EVIDENCE: II

Telemedicine provision of medical abortion is effective compared with standard face-to-face provision and may be more acceptable to women who choose it.

From Ibis Reproductive Health, Oakland, California, and Cambridge, Massachusetts; the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California; Planned Parenthood of the Heartland, Des Moines, Iowa; Abortion Access Project, Cedar Rapids, Iowa.

Funded by a grant from an anonymous donor.

We thank Melanie Zurek for her input on study design as well as the clinic staff at each of the study sites who assisted with data collection.

Corresponding author: Daniel Grossman, MD, Ibis Reproductive Health, 1330 Broadway, Ste 1100, Oakland, CA 94612; e-mail: DGrossman@ibisreproductivehealth.org.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists.