Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

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Abstract

<jats:sec> <jats:title>Objective</jats:title> <jats:p>To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.</jats:p> </jats:sec> <jats:sec> <jats:title>Design</jats:title> <jats:p>Cohort analysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Setting</jats:title> <jats:p>The three main abortion providers.</jats:p> </jats:sec> <jats:sec> <jats:title>Population or sample</jats:title> <jats:p> Medical abortions at home at ≤69 days’ gestation in two cohorts: traditional model (in‐person with ultrasound, <jats:italic>n</jats:italic>  = 22 158) from January to March 2020 versus telemedicine‐hybrid model (either in person or via telemedicine without ultrasound, <jats:italic>n</jats:italic>  = 29 984, of whom 18 435 had no‐test telemedicine) between April and June 2020. Sample ( <jats:italic>n</jats:italic>  = 52 142) comprises 85% of all medical abortions provided nationally. </jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.</jats:p> </jats:sec> <jats:sec> <jats:title>Main outcome measures</jats:title> <jats:p>Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p> Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine‐hybrid model and more abortions were provided at ≤6 weeks’ gestation (40% versus 25%, <jats:italic>P</jats:italic>  &lt; 0.001). Treatment success (98.8% versus 98.2%, <jats:italic>P</jats:italic>  &gt; 0.999), serious adverse events (0.02% versus 0.04%, <jats:italic>P</jats:italic>  = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, <jats:italic>P</jats:italic>  = 0.796) were not different between models. In the telemedicine‐hybrid model, 0.04% were estimated to be over 10 weeks’ gestation at the time of the abortion; all were completed safely at home. Within the telemedicine‐hybrid model, effectiveness was higher with telemedicine than in‐person care (99.2% versus 98.1%, <jats:italic>P</jats:italic>  &lt; 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>A telemedicine‐hybrid model for medical abortion that includes no‐test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.</jats:p> </jats:sec> <jats:sec> <jats:title>Tweetable abstract</jats:title> <jats:p>Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care.</jats:p> </jats:sec>