Sheila Dunn1, Dilzayn Panjwani2, Melini Gupta3, Christopher Meaney4, Rebecca Morgan5, Erika Feuerstein6. 1. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada. Electronic address: sheila.dunn@wchospital.ca. 2. Women's College Research Institute, Toronto, ON, Canada. Electronic address: dilzayn.panjwani@wchospital.ca. 3. Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: melini.gupta@mail.utoronto.ca. 4. Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: christopher.meaney@utoronto.ca. 5. Choice in Health Clinic, Toronto, ON, Canada. Electronic address: rebecca.morgan.ec@gmail.com. 6. Women's College Hospital, Toronto, ON, Canada; Choice in Health Clinic, Toronto, ON, Canada. Electronic address: erika.feuerstein@wchospital.ca.
Abstract
OBJECTIVE: This study compared adherence to follow-up and clinical outcomes between standard in-clinic and remote follow-up after methotrexate/misoprostol abortion. STUDY DESIGN: This nonrandomized trial recruited women requesting medical abortion at two sexual health clinics in Toronto, Canada. Women received methotrexate 50 mg/m(2) followed 3-7 days later by 800 mcg of misoprostol self-administered vaginally. For Day 15, follow-up participants could choose standard in-clinic follow-up with ultrasound and assessment or remote telephone follow-up with serum β-hCG performed at a community laboratory and symptom checklist. Standard and remote follow-up groups were compared for adherence, defined as completing follow-up within 7 days of the scheduled time, and clinical outcomes. Characteristics associated with adherence were assessed using multivariable logistic regression. RESULTS: Of 129 women, 86 (67%) chose remote follow-up. Nonadherence rates for remote (28%) and standard (23%) follow-up groups did not differ in univariate (p=.57) or multivariable analysis (odds ratio: 1.09, 95% confidence interval: 0.39-3.01). Rates of emergency/hospital visits were 3% and 9% for remote and standard groups, respectively (p=.22), and complete loss to follow was 6% and 14% in remote and standard groups (p=.18). Nonadherent women were more likely to be undecided about their contraception (65% vs. 28%; p=.002), and this difference persisted in the multivariable analysis. CONCLUSION: Given a choice of remote or in-clinic follow-up after methotrexate/misoprostol abortion, most women chose remote follow-up. Rates of adherence to follow-up, adverse outcomes and complete loss to follow-up were similar for women choosing remote and standard follow-up. IMPLICATIONS STATEMENT: Since standard and remote follow-up after methotrexate/misoprostol abortion are associated with similar adherence to follow-up and similar safety profiles, women should be offered their choice of follow-up method.
OBJECTIVE: This study compared adherence to follow-up and clinical outcomes between standard in-clinic and remote follow-up after methotrexate/misoprostol abortion. STUDY DESIGN: This nonrandomized trial recruited women requesting medical abortion at two sexual health clinics in Toronto, Canada. Women received methotrexate 50 mg/m(2) followed 3-7 days later by 800 mcg of misoprostol self-administered vaginally. For Day 15, follow-up participants could choose standard in-clinic follow-up with ultrasound and assessment or remote telephone follow-up with serum β-hCG performed at a community laboratory and symptom checklist. Standard and remote follow-up groups were compared for adherence, defined as completing follow-up within 7 days of the scheduled time, and clinical outcomes. Characteristics associated with adherence were assessed using multivariable logistic regression. RESULTS: Of 129 women, 86 (67%) chose remote follow-up. Nonadherence rates for remote (28%) and standard (23%) follow-up groups did not differ in univariate (p=.57) or multivariable analysis (odds ratio: 1.09, 95% confidence interval: 0.39-3.01). Rates of emergency/hospital visits were 3% and 9% for remote and standard groups, respectively (p=.22), and complete loss to follow was 6% and 14% in remote and standard groups (p=.18). Nonadherent women were more likely to be undecided about their contraception (65% vs. 28%; p=.002), and this difference persisted in the multivariable analysis. CONCLUSION: Given a choice of remote or in-clinic follow-up after methotrexate/misoprostol abortion, most women chose remote follow-up. Rates of adherence to follow-up, adverse outcomes and complete loss to follow-up were similar for women choosing remote and standard follow-up. IMPLICATIONS STATEMENT: Since standard and remote follow-up after methotrexate/misoprostol abortion are associated with similar adherence to follow-up and similar safety profiles, women should be offered their choice of follow-up method.
Authors: Esteban Ortiz-Prado; Katherine Simbaña; Lenin Gómez; Anna M Stewart-Ibarra; Lisa Scott; Gabriel Cevallos-Sierra Journal: Pragmat Obs Res Date: 2017-07-13
Authors: Heidi E Jones; Katharine O'Connell White; Wendy V Norman; Edith Guilbert; E Steve Lichtenberg; Maureen Paul Journal: PLoS One Date: 2017-10-12 Impact factor: 3.240