TelAbortion: evaluation of a direct to patient telemedicine abortion service in the United States

Contraception. 2019 Sep;100(3):173-177. doi: 10.1016/j.contraception.2019.05.013. Epub 2019 Jun 4.

Abstract

Objectives: To evaluate the safety, feasibility, and acceptability of a direct-to-patient telemedicine service that enabled people to obtain medical abortion without visiting an abortion provider in person.

Study design: We offered the service in five states. Each participant had a videoconference with a study clinician and had pre-treatment laboratory tests and ultrasound at facilities of her choice. If the participant was eligible for medical abortion, the clinician sent a package containing mifepristone, misoprostol, and instructions to her by mail. After taking the medications, the participant obtained follow-up tests and had a follow-up consultation with the clinician by telephone or videoconference to evaluate abortion completeness. The analysis was descriptive.

Results: Over 32 months, we conducted 433 study screenings and shipped 248 packages. The median interval between screening and mailing was 7 days (91st percentile 17 days), and no participant took the mifepristone at ≫71 days of gestation. We ascertained abortion outcomes of 190/248 package recipients (77%): 177/190 (93%) had complete abortion without a procedure. Of the 217/248 package recipients who provided meaningful follow-up data (88%), one was hospitalized for postoperative seizure and another for excessive bleeding, and 27 had other unscheduled clinical encounters, 12 of which resulted in no treatment. A total of 159/248 participants who received packages (64%) completed satisfaction questionnaires at study exit; all were satisfied with the service.

Conclusions: This direct-to-patient telemedicine abortion service was safe, effective, efficient, and satisfactory. The model has the potential to increase abortion access by enhancing the reach of providers and by offering people a new option for obtaining care conveniently and privately.

Implications: Provision of medical abortion by direct-to-patient telemedicine and mail has the potential to increase abortion access by increasing the reach of providers and by offering people the option of obtaining abortion care without an in-person visit to an abortion provider.

Keywords: Mail; Medical abortion; Telemedicine; United States.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortifacient Agents / administration & dosage*
  • Abortion, Induced / methods*
  • Adolescent
  • Adult
  • Female
  • Humans
  • Middle Aged
  • Mifepristone / administration & dosage*
  • Misoprostol / administration & dosage*
  • Outcome Assessment, Health Care
  • Patient Satisfaction / statistics & numerical data*
  • Pregnancy
  • Self Administration
  • Telemedicine*
  • United States
  • Young Adult

Substances

  • Abortifacient Agents
  • Misoprostol
  • Mifepristone