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Research project

Telemedicine of Medication Abortion

- back to Novel Abortion Provision Models

The practice of telemedicine—accessing care remotely from a doctor or nurse via phone or teleconference to address a health need—is a rapidly growing segment of the healthcare landscape.  Forbes called it a “game-changer for patients.” ANSIRH partners with Ibis Reproductive Health on work that explores the potential of telemedicine to improve access to abortion care.

Abortion in the United States has become increasingly difficult to access, particularly with the closure of abortion clinics and an already insufficient number of abortion providers. A recent study by ANSIRH researchers found that there are 27 “abortion deserts” in the US, or cities where the lack of abortion facilities may force people to travel over 100 miles to get abortion care. Provision of medication abortion by telemedicine has the potential to fill some of those deserts, especially when combined with delivery of mifepristone and misoprostol by mail-order. Research in several states is evaluating the impact of telemedicine on abortion care.

Iowa

The first telemedicine abortion program began in Iowa in 2008. Between 2008 and 2015, Planned Parenthood clinics in the state performed 8,765 medication abortions via telemedicine, all following the same protocol. A patient came in to the clinic for an intake appointment, including an ultrasound, and a provider reviewed her images and medical history remotely. The provider spoke with the patient via videoconference, after which the provider entered a password to unlock a drawer in front of the patient, where the medication abortion pills were held. The patient took the first pill, mifepristone, in front of the provider via videoconference, and the second pill at home. Within two weeks, the patient returned to the clinic for a follow-up to ensure the abortion was complete.

Daniel Grossman and Ibis Reproductive Health evaluated this service and found that telemedicine provision of medication abortion is safe, effective, and acceptable to patients and providers. Ninety-nine percent of telemedicine patients had a successful abortion, and adverse events, such as going to the emergency room or needing a blood transfusion, were rare, occurring among 1% of patients seen either by telemedicine or in a comparison group of patients seen face-to-face by a physician. While satisfaction with the abortion was high among all patients (91% reported they were ‘very satisfied’), telemedicine patients were more likely to report they would recommend the service to a friend compared with face-to-face patients. This work also showed that telemedicine availability resulted in people accessing abortion services at earlier gestational ages and increased access to services for people living in remote parts of the state.

ANSIRH and Ibis continue to explore the ways in which telemedicine can be used to expand and improve access to quality abortion care. To learn more about this project or to stay up-to-date with research developments, please visit the Ibis project page.

Utah

Utah state law requires a 72-hour mandatory delay between attending a face-to-face abortion information visit and the abortion procedure itself. Utah has nine clinics where patients can attend information visits in person, but only two clinics that provide abortion care. In the predominantly rural state, many people travel over 100 miles one-way to get to a clinic.

In January 2015, to ease the travel burdens on patients, Planned Parenthood Affiliates of Utah (PPAU) began offering the option of completing the state-mandated abortion information visit by videoconference. ANSIRH’s UTEP study seeks to explore the experiences of people who use telemedicine to attend state-mandated information visits in Utah. Researchers are using qualitative and quantitative methods to examine the differences between in-clinic and telemedicine information sessions in the following areas:

  • Demographic differences of the patients choosing each method
  • Patient satisfaction with each method
  • Reasons why patients choose each method
  • Patients experiences with each method

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ANSIRH is a program within the UCSF Bixby Center for Global Reproductive Health and is a part of UCSF's Department of Obstetrics, Gynecology & Reproductive Sciences.

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