Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.
BJOG
; 128(9): 1464-1474, 2021 08.
Article
in English
| MEDLINE | ID: covidwho-1337350
ABSTRACT
OBJECTIVE:
To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.DESIGN:
Cohort analysis.SETTING:
The three main abortion providers. POPULATION OR SAMPLE Medical abortions at home at ≤69 days' gestation in two cohorts traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.METHODS:
Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. MAIN OUTCOMEMEASURES:
Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.RESULTS:
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%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 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%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.CONCLUSIONS:
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. TWEETABLE ABSTRACT Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Abortion, Induced
/
Telemedicine
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
/
Randomized controlled trials
Limits:
Female
/
Humans
/
Pregnancy
Country/Region as subject:
Europa
Language:
English
Journal:
BJOG
Journal subject:
Gynecology
/
Obstetrics
Year:
2021
Document Type:
Article
Affiliation country:
1471-0528.16668
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