Family medicine provision of online medication abortion in three US states during COVID-19

Abstract

Objective: To examine provision of direct-to-patient medication abortion during COVID-19 by United States family physicians through a clinician-supported, asynchronous online service, Aid Access. Study Design: We analyzed data from United States residents in New Jersey, New York, and Washington who requested medication abortion from 3 family physicians using the online service from Aid Access between April and November 2020. This study seeks to examine individual characteristics, motivations, and geographic locations of patients receiving abortion care through the Aid Access platform. Results: Over 7 months, three family physicians using the Aid Access platform provided medication abortion care to 534 residents of New Jersey, New York, and Washington. There were no demographic differences between patients seeking care in these states. A high percentage (85%) were less than 7 weeks gestation at the time of their request for care. The reasons patients chose Aid Access for abortion services were similar regardless of state residence. The majority (71%) of Aid Access users lived in urban areas. Each family physician provided care to most counties in their respective states. Among those who received services in the three states, almost one-quarter (24%) lived in high Social Vulnerability Index (SVI) counties, with roughly one-third living in medium-high SVI counties (33%), followed by another quarter (26%) living in medium-low SVI counties. Conclusions: Family physicians successfully provided medication abortion in three states using asynchronous online consultations and medications mailed directly to patients. Implications: Primary care patients are requesting direct-to-patient first trimester abortion services online. By providing abortion care online, a single provider can serve the entire state, thus greatly increasing geographic access to medication abortion.

Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review

“…A total of 39 of the 44 studies (89%) mentioned the types of ICT used in PHC. Telephone calls had the highest number of records (29/39, 74%) [ 30 , 31 , 33 - 38 , 40 , 44 - 48 , 50 , 52 , 53 , 55 - 60 , 62 , 65 , 66 , 69 , 70 , 72 ], followed by video calls (25/39, 64%) [ 30 , 31 , 33 - 41 , 43 - 48 , 55 , 60 , 62 - 65 , 69 , 72 ], patient portal (11/39, 28%) [ 31 , 33 , 35 - 37 , 40 , 42 , 44 , 58 , 61 , 72 ], smartphone apps (5/39, 13%) [ 44 , 49 , 52 , 54 , 68 ], text messages (3/39, 8%) [ 35 , 46 , 60 ], email (3/39, 8%) [ 46 , 62 , 72 ], electronic medical record (2/39, 5%) [ 31 , 72 ], and social networks (1/39, 3%) [ 46 ]. We highlight that many studies used more than one type of technology, mainly phone and video calls.…”

“…Actions were mostly directed to the general public (ie, any health status or characteristic) [ 29 , 31 , 32 , 34 - 36 , 38 , 40 - 42 , 44 , 46 , 48 , 49 , 51 , 53 , 55 , 56 , 58 - 60 , 63 , 67 , 71 ]. Regarding professionals who conducted the actions, the majority were clinicians [ 29 - 31 , 34 , 36 - 38 , 42 , 44 - 46 , 49 - 51 , 54 , 55 , 57 , 58 , 60 , 63 - 66 , 69 , 71 , 72 ] and nurses [ 35 , 39 , 41 , 43 , 47 , 48 , 56 , 70 , 72 ]. Actions were directed toward people with and without COVID-19 [ 31 , 32 , 34 , 36 , 38 , 40 , 42 , 44 , 49 , 51 , 53 - 56 , 58 - 63 , 65 , 67 , <...>…”

Exploring the impact of mifepristone's risk evaluation and mitigation strategy (REMS) on the integration of medication abortion into US family medicine primary care clinics✰,✰✰

“…In the United States, models such as ExPAND Mifepristone demonstrate that learning collaborations that provide evidence-based knowledge on the clinical use of mifepristone and expertise on best practices to navigate the administrative logistics are important aspects of reducing logistical and psychological barriers to abortion provision in primary settings [ 30 ]. In addition, recent models of online provision of medication abortion by family physicians provide encouraging direction for expanding care [ 31 , 32 ]. These broad efforts will likely be necessary, alongside the full elimination of the REMS, to reduce stigma and optimize provision of medication abortion in primary care settings.…”

“I just was really scared, because it's already such an uncertain time”: Exploring women's abortion experiences during the COVID-19 pandemic in Canada

“…However, the COVID-19 pandemic also provides a window of opportunity to consider new and innovative models of medication abortion service delivery. Providers in a number of countries, including the United Kingdom [35][36] and the United States [37][38], initiated or expanded telemedicine services that included fully remote protocols. The evidence is overwhelming that these services were safe, effective, and acceptable to both providers and patients.…”