Background Medical abortion provided via telemedicine is becoming more widely available, potentially decreasing travel time for in-person abortion evaluation.
Methods We conducted a retrospective chart review of all outpatient medical abortions from October 2016 through December 2019 at our academic medical centre in Portland, Oregon, USA. Using mifepristone administration logs, we identified patients who underwent abortion via direct-to-patient telemedicine or in clinic. Both groups had pre-abortion ultrasound examination. We extracted patient characteristics and geographic data to compare travel distance to clinic, ultrasound facility, and nearest advertised abortion clinic. We compared time from first contact until mifepristone ingestion and gestational age at mifepristone ingestion.
Results Median distance from mailing address to clinic for 80 telemedicine and 124 clinic medical abortions was 95 (range 4–377) and 12 (range 0–184) miles (p<0.01). Distance travelled to ultrasound facility was shorter for telemedicine patients (median 7 miles, range 0–150 vs 12 miles, range 0–184; p<0.01) excluding outliers >200 miles. Distance to nearest advertised abortion clinic was equal between groups (median 7 miles, p=0.4). Time to mifepristone administration (ingestion) was longer (11 vs 6 days; p<0.01) and median gestational age was higher (49 vs 44 days; p=0.01) for telemedicine.
Conclusions Telemedicine increases the reach of abortion providers and provides care to more geographically distant patients. Patients chose telemedicine abortion even when they had an equidistant option, suggesting that patients value telemedicine for reasons other than geographic convenience. This telemedicine delivery model that included ultrasound testing prior to abortion resulted in up to a 5-day delay in abortion initiation, which was not clinically significant.
Data availability statement
Limited data are available upon request.
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Contributors KMB conceived the study idea, drafted the protocol, collected data, analysed data and drafted the majority of the manuscript. UD participated in data collection and manuscript editing. ER participated in protocol design and manuscript preparation. MKB participated in protocol development, data collection, data analysis and manuscript preparation.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests ER is employed by Gynuity Health Projects, the TelAbortion Study sponsor. MKB is the principal investigator of the TelAbortion Study at Oregon Health & Science University.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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