Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic

Chong, Erica; Shochet, Tara; Raymond, Elizabeth G.; Platais, Ingrida; Anger, H; Raidoo, Shandhini; Soon, Reni; Grant, Melissa; Haskell, Susan; Tocce, Kristina; Baldwin, Maureen K.; Boraas, Christy M.; Bednarek, Paula H.; Banks, Joey; Coplon, Leah; Thompson, Francine; Priegue, Esther; Winikoff, Beverly

doi:10.1016/j.contraception.2021.03.019

Cited by 77 publications

(121 citation statements)

References 17 publications

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“…We look forward to completing recruitment for the study in the coming year, which will provide more precise estimates of the effectiveness, acceptability, and feasibility of medication abortion with mail-order pharmacy dispensing of mifepristone. However, these interim results, together with studies of other care models that include mailing pills for medication abortion [23][24][25][26] and pharmacist dispensing at brick-and-mortar pharmacies [3], support the removal of the FDA's in-person dispensing requirement for mifepristone.…”

Section: Discussionmentioning

confidence: 95%

Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment

Grossman¹,

Raifman²,

Morris³

et al. 2022

Contraception

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 95%

Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment

Grossman¹,

Raifman²,

Morris³

et al. 2022

Contraception

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“…Endler and colleagues’ systematic review was conducted prior to the COVID-19 pandemic. As such, there is now a significant body of more recent research to corroborate their findings [ 3 , 14 , 39 , 41 ]. Of particular relevance to our discussion is a study conducted across the three main abortion providers in England to examine the safety, effectiveness, and acceptability of their TEMA care pathways [ 3 ].…”

Section: Tema and Safeguarding Concernsmentioning

confidence: 95%

The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Parsons

Romanis

2021

Health Care Anal

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Access to abortion care has been hugely affected by the COVID-19 pandemic. This has prompted several governments to permit the use of telemedicine for fully remote care pathways, thereby ensuring pregnant people are still able to access services. One such government is that of England, where these new care pathways have been publicly scrutinised. Those opposed to telemedical early medical abortion care have raised myriad concerns, though they largely centre on matters of patient safeguarding. It is argued that healthcare professionals cannot adequately carry out their safeguarding duties if the patient is not in the room with them. These concerns lack empirical support. Emerging evidence suggests that safeguarding processes may, in fact, be more effective within telemedical abortion care pathways. In this article, we address two specific safeguarding concerns: (1) that a remote consultation prevents a healthcare professional from identifying instances of abuse, and (2) that healthcare professionals cannot reliably confirm the absence of coercion during a remote consultation. We demonstrate that such concerns are misplaced, and that safeguarding may actually be improved in telemedical care pathways as victims of abuse may find it easier to engage with services. It is inevitable that some individuals will fall through the net, but this is unavoidable even with in-person care and thus does not constitute a strong critique of the use of telemedicine in abortion care. These safeguarding concerns set aside, then, we argue that the current approval that enables telemedical early medical abortion should be afforded permanence.

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“…13,14 When evidence-based guidelines are followed, efficacy can be greater than 95% but ranges from 92% to 98% depending on the gestational age and specific medication guidelines that are being followed. 10,13,19,20 Risk of serious complications is less than 0.5%. 10,13,19,20 Because abortion with pills is relatively simple to provide from a clinical perspective, this method has potential to increase access to early abortion, which in turn contributes to greater safety and costeffectiveness overall.…”

Section: The Status Of Mifepristonementioning

confidence: 99%

“…10,13,19,20 Risk of serious complications is less than 0.5%. 10,13,19,20 Because abortion with pills is relatively simple to provide from a clinical perspective, this method has potential to increase access to early abortion, which in turn contributes to greater safety and costeffectiveness overall. 10,14,[17][18][19][20] However, in many states, various restrictions have been placed that limit accessibility to abortion with pills, including by limiting the pool of prescribers of mifepristone to physicians, banning delivery of abortion care via telehealth, requiring ultrasound and/or other testing (such as Rh and hemoglobin) before medications can be dispensed, as well as other strategies.…”

Section: The Status Of Mifepristonementioning

confidence: 99%

Abortion With Pills: Review of Current Options in The United States

Jenkins

Woodside

Lipinsky

et al. 2021

J Midwife Womens Health

Self Cite

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Interest in self-management approaches to abortion with pills in the United States preceded the coronavirus disease 2019 (COVID-19) pandemic and has accelerated during this global health crisis. Coupled with the unclear future of legal abortion in the United States, clinical care providers need to be aware of the range of self-managed abortion approaches and of the varying levels of engagement with the formal health care system they entail. This article is intended to serve as a resource to inform providers of the current landscape of abortion with pills in the United States, while also describing possible shifts in the future that may result due to the ongoing pandemic and the continuing erosion of access to abortion care and services.

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Expansion of a direct-to-patient telemedicine abortion service in the United States and experience during the COVID-19 pandemic

Cited by 77 publications

References 17 publications

Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment

Mail-order pharmacy dispensing of mifepristone for medication abortion after in-person clinical assessment

The Case for Telemedical Early Medical Abortion in England: Dispelling Adult Safeguarding Concerns

Abortion With Pills: Review of Current Options in The United States

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