Barriers to Telemedicine for First-Trimester Medical Abortion Provision in Canada in 2019

ABSTRACT

Objectives: In 2017, mifepristone became available for first trimester medical abortion (FTMA) in Canada. Shortly after, regulations permitted pharmacies to dispense mifepristone to patients, facilitating telemedicine provision. Our objective was to explore the barriers to providing FTMA using telemedicine in Canada in 2019. Methods: We conducted a cross-sectional, national, self-administered, anonymized survey of physicians and nurse practitioners who provided abortion care in Canada in 2019. Online invitations were sent through professional health organizations using a modified Dillman technique to optimize recruitment. Questions elicited provider demographics and perceived barriers to offering telemedicine FTMA. We used R software for descriptive statistics. Results: Four hundred sixty-five clinicians were included for analyses, of which 388 reported providing FTMA. Among those, 44.0% reported using telemedicine (for consultations, while often obtaining testing) for FTMA. British Columbia respondents reported the highest proportion of telemedicine use at 63.8%;the lowest was in Québec (10.7%). The majority of FTMA respondents (77.7%) reported barriers to telemedicine. The most common barriers were inability to confirm gestational age with ultrasound (43.0%), and lack of provincial fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Few reported facility regulations (8.9%) and provincial regulations (4.9%) as barriers to providing telemedicine-based care;provincial regulation barriers were most common in Québec (16.1%). Conclusions: Less than half of respondents reported providing some abortion care via telemedicine and the majority perceived barriers. Low-test medical abortion protocols developed during COVID-19 have the potential to overcome some barriers. Keywords telemedicine;abortion, induced;surveys and questionnaires;Canada;delivery of health care;mifepristone