Effectiveness and Acceptability of Medical Abortion Provided Through Telemedicine.
Grossman, Daniel MD; Grindlay, Kate MSPH; Buchacker, Todd RN; Lane, Kathleen; Blanchard, Kelly MSc
Obstetrics & Gynecology.
118(2, Part 1):296-303, August 2011.
(Format: HTML, PDF)
OBJECTIVE: To estimate the effectiveness and acceptability of telemedicine provision of early medical abortion compared with provision with a face-to-face physician visit at a Planned Parenthood affiliate in Iowa.
METHODS: Between November 2008 and October 2009, we conducted a prospective cohort study of women obtaining medical abortion by telemedicine or face-to-face physician visits. We collected clinical data, and women completed a self-administered questionnaire at follow-up. We also compared the prevalence of reportable adverse events between the two service delivery models among all patients seen between July 2008 and October 2009.
RESULTS: Of 578 enrolled participants, follow-up data were obtained for 223 telemedicine patients and 226 face-to-face patients. The proportion with a successful abortion was 99% for telemedicine patients (95% confidence interval [CI] 96-100%) and 97% for face-to-face patients (95% CI 94-99%). Ninety-one percent of all participants were very satisfied with their abortion, although in multivariable analysis, telemedicine patients had a higher odds of saying they would recommend the service to a friend compared with face-to-face patients (odds ratio, 1.72; 95% CI 1.26-2.34). Twenty-five percent of telemedicine patients said they would have preferred being in the same room with the doctor. Younger age, less education, and nulliparity were significantly associated with preferring face-to-face communication. There was no significant difference in the prevalence of adverse events reported during the study period among telemedicine patients (n=1,172) (1.3%; 95% CI 0.8-2.1%) compared with face-to-face patients (n=2,384) (1.3%; 95% CI 0.9-1.8%) (82% power to detect difference of 1.3%).
CONCLUSION: Provision of medical abortion through telemedicine is effective and acceptability is high among women who choose this model.
LEVEL OF EVIDENCE: II
(C) 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.