Elizabeth Raymond1, Erica Chong2, Beverly Winikoff3, Ingrida Platais4, Meighan Mary5, Tatyana Lotarevich6, Philicia W Castillo7, Bliss Kaneshiro8, Mary Tschann9, Tiana Fontanilla10, Maureen Baldwin11, Ariela Schnyer12, Leah Coplon13, Nicole Mathieu14, Paula Bednarek15, Meghan Keady16, Esther Priegue17. 1. Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: eraymond@gynuity.org. 2. Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: echong@gynuity.org. 3. Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: bwinikoff@gynuity.org. 4. Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: iplatais@gynuity.org. 5. Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: mtarnagada@gynuity.org. 6. Gynuity Health Projects, 220 East 42nd Street New York, NY 10017. Electronic address: tlotarevich@gynuity.org. 7. Guttmacher Institute, 125 Maiden Lane, 7th Floor, New York, NY 10038, USA. Electronic address: pcastillo@guttmacher.org. 8. Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826. Electronic address: blissk@hawaii.edu. 9. Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826; Society of Family Planning, 225 South 17th Street, Suite 2709, Philadelphia, PA 19103-0046. Electronic address: mtschann@societyfp.org. 10. Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii John A. Burns School of Medicine, 1319 Punahou Street, Suite 824, Honolulu, HI 96826. Electronic address: tianamf@hawaii.edu. 11. Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239. Electronic address: schaum@ohsu.edu. 12. Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239. Electronic address: schnyer@ohsu.edu. 13. Maine Family Planning, PO Box 587, Augusta, ME 04332. Electronic address: lcoplon@mainefamilyplanning.org. 14. Maine Family Planning, PO Box 587, Augusta, ME 04332. Electronic address: nmathieu@mainefamilyplanning.org. 15. Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, OR 97239; Planned Parenthood Columbia Willamette, 3727 NE Martin Luther King Jr. Blvd, Portland, OR 97212. Electronic address: paula.bednarek@ppcw.org. 16. Planned Parenthood Columbia Willamette, 3727 NE Martin Luther King Jr. Blvd, Portland, OR 97212. Electronic address: meghan.keady@ppcw.org. 17. Choices Women's Medical Center, 147-32 Jamaica Ave, Jamaica, NY 11435. Electronic address: epriegue@choicesmedical.com.
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.
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.
Authors: Anna E Fiastro; Sajal Sanan; Elizabeth Jacob-Files; Elisa Wells; Francine Coeytaux; Molly R Ruben; Ian M Bennett; Emily M Godfrey Journal: Ann Fam Med Date: 2022-07-13 Impact factor: 5.707
Authors: Elizabeth G Raymond; Daniel Grossman; Alice Mark; Ushma D Upadhyay; Gillian Dean; Mitchell D Creinin; Leah Coplon; Jamila Perritt; Jessica M Atrio; DeShawn Taylor; Marji Gold Journal: Contraception Date: 2020-04-16 Impact factor: 3.375