Factors associated with successful implementation of telehealth abortion in 4 United States clinical practice settings

Contraception. 2021 Jul;104(1):82-91. doi: 10.1016/j.contraception.2021.04.021. Epub 2021 Apr 29.


Objective: To overcome obstacles to delivering medication abortion services during the COVID-19 pandemic, clinics and providers implemented new medication abortion service models not requiring in-person care. This study identifies organizational factors that promoted successful implementation of telehealth and adoption of "no test" medication abortion protocols.

Study design: We conducted 21 semi-structured, in-depth interviews with health care providers and clinic administrators implementing clinician-supported telehealth abortion during the COVID pandemic. We selected 15 clinical sites to represent 4 different practice settings: independent primary care practices, online medical services, specialty family planning clinics, and primary care clinics within multispecialty health systems. The Consolidated Framework for Implementation Research guided our thematic analysis.

Results: Successful implementation of telehealth abortion included access to formal and informal inter-organizational networks, including professional organizations and informal mentorship relationships with innovators in the field; organizational readiness for implementation, such as having clinic resources available for telehealth services like functional electronic health records and options for easy-to-use virtual patient-provider interactions; and motivated and effective clinic champions.

Conclusions: In response to the need to offer remote clinical services, 4 different practice settings types leveraged key operational factors to facilitate successful implementation of telehealth abortion. Information from this study can inform implementation strategies to support the dissemination and adoption of this model.

Implications: Examples of successfully implemented telehealth medication abortion services provide a framework that can be used to inform and implement similar patient-centered telehealth models in diverse practice settings.

Keywords: Abortion; Implementation; Medication abortion; Qualitative study; Telehealth; Telemedicine.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Abortifacient Agents / therapeutic use*
  • Abortion, Induced / methods*
  • Ambulatory Care Facilities / organization & administration*
  • COVID-19
  • Electronic Health Records
  • Health Personnel*
  • Humans
  • Implementation Science
  • Organizational Innovation
  • Patient Participation
  • Primary Health Care / organization & administration*
  • SARS-CoV-2
  • Telemedicine / methods
  • Telemedicine / organization & administration*
  • United States


  • Abortifacient Agents