Safety of Medical Abortion Provided Through Telemedicine Compared With In Person

Grossman, Daniel; Grindlay, Kate

doi:10.1097/aog.0000000000002212

Cited by 100 publications

(108 citation statements)

References 11 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…Two studies, which included women ≤10 +0 GW, reported use between 0.8 and 2.6%; one study which also included women >10 +0 GW, reported antibiotic use at 9.3% (Table ) . Other reported secondary outcomes were rate of clinical visits for complications after abortion (range 14.6–24.9%), rate of heavy bleeding (range 3.4–5.2%), and emergency visits with treatment (0.15% among TM patients and 0.21% for in‐person patients, P = 0.31) …”

Section: Resultsmentioning

confidence: 99%

“…There were no randomised clinical trials, and most of the data came from descriptive studies and were based on self‐reported outcomes. Two observational studies assessed the safety and success rate of TM in direct comparison with in‐person care which adds to the reliability of these results . Seven of nine of the remaining studies represented study populations for whom abortion is legally restricted, meaning that no comparison group would have been accessible.…”

Section: Discussionmentioning

confidence: 99%

“…Pre-and post-abortion ultrasound are done in-clinic by a medical technician, but ultrasound assessment, informed consent, and witnessed intake of mifepristone 200 mg (in accordance with Iowa State legal requirements) 35 is performed off-site by a physician through an encrypted digital videoconference system. 36,[39][40][41] One study with 19 participants was based on data from Willow's Women's Clinic in Vancouver, which has had a TM abortion care option for women in British Columbia since 2012. 38 Pre-abortion assessment is performed by Skype Videoconference.…”

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Telemedicine for medical abortion: a systematic review

Endler

Lavelanet

Cleeve

et al. 2019

BJOG

175

179

View full text Add to dashboard Cite

Background Telemedicine is increasingly being used to access abortion services. Objective To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine. Search strategy We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017. Study criteria We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service). Data collection and analysis Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis. Main results Rates relevant to success rate, safety, and acceptability outcomes for women ≤10+0 weeks’ gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10+0 GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers. Conclusion Based on a synthesis of mainly self‐reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in‐person abortion care, and surgical evacuation rates are higher. Tweetable abstract A systematic review of medical abortion through telemedicine shows outcome rates similar to in‐person care.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Telemedicine for medical abortion: a systematic review

Endler

Lavelanet

Cleeve

et al. 2019

BJOG

175

179

View full text Add to dashboard Cite

show abstract

“…Some states have already managed this through an expansion of medication abortion-only services and increased use of telemedicine, which has been demonstrated to be safe and acceptable to women and to decrease travel for patients [33]. While 19 states (almost exclusively in the South and Midwest)…”

Section: Abortion Desertsmentioning

confidence: 99%

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search (Preprint)

Cartwright¹,

Karunaratne²,

Barr‐Walker³

et al. 2017

Preprint

View full text Add to dashboard Cite

Background: Abortion is a common medical procedure, yet its availability has become more limited across the United States (US) over the past decade. Although women may not always know where to go for abortion care, they often use the internet to find reproductive health information and there appear to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used systematic online searches to document the current geographic locations and services of abortion facilities.Objective: To describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify U.S. cities where people must travel the farthest to obtain abortion care.Methods: In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits and summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper methodology, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all U.S. cities with populations ≥50,000.Results: 780 facilities were identified through our online search, with the fewest in the Midwest and South. Over 30% of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast and West. The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 U.S. cities must travel over 100 miles to reach an abortion facility; the largest number of such cities is in Texas which has 10.Conclusions: Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically and many large U.S. cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited.

show abstract

“…Providing information about medication abortion via ‘harm reduction’ services,3 4 accessing medication abortion medicines via the internet5 6 or with support from safe abortion hotlines6–8 and buying medication abortion medicines over-the-counter without a healthcare provider intermediary9 have all been shown to be safe and effective ways to access medication abortion in legally restricted settings, increasing access to a critical health service and reducing the risks and sequelae of unsafe abortion. In addition, in settings where abortion is legal, telemedicine services that connect people to providers via a video conference10 have been shown to be safe and effective, and researchers are currently assessing both direct-to-person mailing of medication abortion medicines as well as telemedicine where people seeking abortion care connect to a provider directly from their home. Information about contraception provided as part of these service modalities can assure people seeking medication abortion that they can start using a contraceptive method at whatever point during the process is convenient for them.…”

mentioning

confidence: 99%

Contraception after medication abortion should be determined by convenience and choice

Blanchard

2018

BMJ Sex Reprod Health

View full text Add to dashboard Cite

Safety of Medical Abortion Provided Through Telemedicine Compared With In Person

Abstract: Adverse events are rare with medical abortion, and telemedicine provision is noninferior to in-person provision with regard to clinically significant adverse events.

Cited by 100 publications

References 11 publications

Telemedicine for medical abortion: a systematic review

Telemedicine for medical abortion: a systematic review

Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search (Preprint)

Contraception after medication abortion should be determined by convenience and choice

Contact Info

Product

Resources

About