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Medication Abortion Provided Through Telemedicine in Four U.S. States

Kohn, Julia E. PhD, MPA; Snow, Jennifer L. MSc; Simons, Hannah R. DrPH; Seymour, Jane W. MPH; Thompson, Terri-Ann PhD; Grossman, Daniel MD

doi: 10.1097/AOG.0000000000003357
Contents: Abortion: Original Research
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OBJECTIVE: To assess outcomes of medication abortion provided through telemedicine compared with standard medication abortion at Planned Parenthood health centers in four U.S. states.

METHODS: In this retrospective cohort study, we analyzed electronic health records for patients receiving telemedicine compared with standard medication abortion at 26 health centers in Alaska, Idaho, Nevada, and Washington from April 2017 to March 2018. All patients had on-site ultrasound scans, laboratory testing, and counseling and provided informed consent before meeting with the clinician. Telemedicine patients met with a clinician by secure videoconference platform; standard patients met with a clinician in person. We also reviewed adverse event reports submitted during this period. Study outcomes included ongoing pregnancy, receipt of or referral for aspiration procedure, and clinically significant adverse events. To compare outcomes between the telemedicine and standard groups, we performed logistic regression accounting for gestational age and health center clustering.

RESULTS: A total of 5,952 patients underwent medication abortion (738 telemedicine and 5,214 standard). Mean gestational age was 50.4 days for telemedicine patients compared with 48.9 days for standard patients (prevalence ratio 1.02; 95% CI 1.00–1.03). We had outcome data for 4,456 (74.9%) patients; follow-up within 45 days of abortion was lower among telemedicine patients (60.3%) than standard patients (76.9%) (prevalence ratio 0.83; 95% CI 0.78–0.88). Among patients with follow-up data, ongoing pregnancy was less common among telemedicine patients (2/445, 0.5%) than standard patients (71/4,011, 1.8%) (adjusted odds ratio [OR] 0.23; 95% CI 0.14–0.39). Aspiration procedures were less common among telemedicine patients (6/445, 1.4%) than standard patients (182/4,011, 4.5%) (adjusted OR 0.28; 95% CI 0.17–0.46). Fewer than 1% of patients in each group reported clinically significant adverse events. No deaths were reported.

CONCLUSION: Findings from this study conducted across geographically diverse settings support existing evidence that outcomes for medication abortion provided through telemedicine are comparable with standard provision of medication abortion. Differences in observed outcomes may be due to differential follow-up between groups.

Medication abortion provided through telemedicine across geographically diverse settings results in comparable outcomes with standard provision of medication abortion.

Planned Parenthood Federation of America, New York, New York; Ibis Reproductive Health, Cambridge, Massachusetts; and Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.

Corresponding author: Julia E. Kohn, PhD, MPA, Planned Parenthood Federation of America, New York, NY; email: julia.kohn@ppfa.org.

Supported by a private grant from the Susan T. Buffett Foundation. The funder had no role in the study design, implementation, analysis, manuscript preparation, or the decision to submit for publication.

Financial Disclosure Dr. Grossman has received consulting payments from Planned Parenthood Federation of America for work related to telemedicine for medication abortion. The other authors did not report any potential conflicts of interest.

The authors thank all of the Planned Parenthood providers and health center staff who worked to launch and provide telemedicine services and contributed data to this study; affiliate staff Jaylyn Bunning, Kristina Tocce, Caitlin Clark, Stephanie Roberts-Dillanes, and Mary Stark for their review of this manuscript; and the PPFA staff who championed this initiative, especially Deborah VanDerhei, Dana Northcraft, and Kelley Wall.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B426.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.