RT Journal Article
SR Electronic
T1 Miles and days until medical abortion via TelAbortion versus clinic in Oregon and Washington, USA
JF BMJ Sexual & Reproductive Health
JO BMJ Sex Reprod Health
FD British Medical Journal Publishing Group
SP bmjsrh-2020-200972
DO 10.1136/bmjsrh-2020-200972
A1 Kathleen Marie Beardsworth
A1 Uma Doshi
A1 Elizabeth Raymond
A1 Maureen K Baldwin
YR 2021
UL http://jfprhc.bmj.com/content/early/2021/03/30/bmjsrh-2020-200972.abstract
AB 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.Limited data are available upon request.