Objectives: In the United States, many women struggle to obtain an abortion due to ever-increasing barriers to access. The TelAbortion Project provides medical abortion directly to women in their homes using telemedicine and mail, enabling them to receive services without going to a clinic. We will report on interim findings from the first two years of the project.
Methods: TelAbortion is available in Hawaii, New York, Maine, Oregon, and Washington. Interested women contact implementing sites and interact with clinicians by videoconference. After obtaining screening tests at radiology and lab facilities close to them, eligible women are mailed packages containing mifepristone and misoprostol. Women take the medications at home, obtain follow-up tests and have another consultation with the clinician.
Results: Through June 2018, 200 women had received medication through the project. Of the 70% who were followed to completion, 5% had a surgical completion. The vast majority of packages were sent within two weeks after the initial study contact, and all women reported taking the mifepristone at gestational ages of 72 days LMP or less. No related serious adverse events were reported. All women reported being very satisfied or satisfied, and the most commonly reported best features of the service were the convenience and privacy.
Conclusions: Direct-to-patient telemedicine abortion is feasible and can potentially increase access to abortion care in a safe and acceptable manner. Although telemedicine bans and other restrictions are on the rise, TelAbortion could plausibly be legally implemented in about half of the 50 states, where about 56% of the female reproductive-age population reside.
The Telabourtion Study: Evaluation of a Direct-to-Patient Telemedicine Abortion Service
Erica Chong, Elizabeth Raymond, Philicia Castillo, Beverly Winikoff
Gynuity Health Projects, New York, NY, USA
Objectives: Given the difficulties women face in obtaining clinic-based abortion in many parts of the US, provision of medical abortion by telemedicine to women in their homes could be highly beneficial for increasing access. We developed a pilot study to obtain preliminary data on the safety, acceptability and feasibility of direct-to-patient telemedicine abortion.
Methods: This case-series study of 50 women is being conducted in selected US states with no legal restrictions on telemedicine abortion. Women may learn about the study from staff at the collabourating study sites, from referring providers or from the study website. Each woman who is interested in the study will consult with a study investigator by videoconference and then will obtain screening tests at local facilities. If the results indicate that she is eligible, the investigator will send the abortion medications to her by mail. The participant will obtain tests at local facilities to confirm abortion completion and will have a follow-up consultation with the investigator by phone or videoconference. Data will be collected about interest in, and satisfaction with, the service, abortion complications and difficulties encountered by patients and providers in completing the protocol requirements.
Results: We will review key legal issues that impact this model and challenges in designing the service to conform to expected standards of care for clinic-based abortion. We will also present data obtained in the project to date.
Conclusions: In states with no legal restrictions, direct-to-consumer telemedicine abortion has great potential to increase women's access to abortion care in a safe and acceptable manner.