New research finds providing medical abortion using telemedicine is effective, safe, and acceptable to women
July 21, 2011 — In 2008 Planned Parenthood of the Heartland in Iowa began offering medical abortion with mifepristone and misoprostol at outlying clinics without a doctor on site using telemedicine. A new study led by Ibis Reproductive Health found that women who obtained medical abortion through the telemedicine service were just as likely to have a successful abortion as women who had an in-person visit with a doctor, and that telemedicine clients were more likely to say they would recommend the service to a friend compared to clients who met with the doctor in person. Medical complications were rare in both groups and women who used the telemedicine service were no more likely to have a complication than women who saw a doctor in person.
Researchers, led by Dr. Daniel Grossman, Senior Associate at Ibis Reproductive Health, followed 450 women between 2008 and 2009 who obtained medical abortions at six Planned Parenthood of the Heartland clinics in Iowa. Half of the women in the study accessed the services through an in-person physician visit and half through a telemedicine visit where the woman spoke to the doctor using video teleconference equipment on a secure dedicated data connection.
All women had an ultrasound performed by a trained technician, received information about medical abortion, and underwent standard informed consent for the abortion. A physician then reviewed the patient’s medical history and ultrasound images, and met with the woman either in person or using video teleconference equipment. The physician determined whether the woman was eligible for medical abortion. In-person patients were handed the mifepristone and misoprostol tablets by the physician. For telemedicine patients, the physician entered a computer password to remotely unlock and open a drawer in front of the patient and her nurse containing the tablets. In all cases, the physician then observed the woman swallow the mifepristone (either in-person or via the video teleconference), and gave her instructions for taking the remaining tablets at home.
According to the study findings, 99% of women who obtained medical abortions through telemedicine had a successful abortion, compared to 97% of in-person patients (there was no statistical difference in likelihood of success). Ninety-one percent of all clients were very satisfied with their abortion, although telemedicine clients were more likely than in-person clients to say that they would recommend the services they received to a friend.
The researchers also analyzed all of the data on adverse events for the more than 3,500 women who underwent medical abortion between July 2008 and October 2009. Few women (1.3%) had a complication related to medical abortion, and there was no difference in the likelihood of adverse events between in-person and telemedicine patients. Most of these adverse events were ongoing pregnancies, but they also included a few cases of blood transfusion or other treatment in the emergency room. “The study shows that medical abortion can be safely offered through telemedicine with the same low risk of complications that has been reported in the literature,” said Grossman.
All patients were told at the time they scheduled their appointment whether they would receive abortion services through telemedicine or not. Twenty-five percent of telemedicine clients said they would have preferred being in the same room with the doctor, with young women, women with a high school education or less, and women without children significantly more likely to prefer in-person communication. “These findings highlight the importance of informing women about what the telemedicine service involves so patients can weigh the options about which service they prefer,” said Grossman. “While a number of the women would have preferred being in the same room with the doctor, it seems that the convenience of having an abortion closer to their home or possibly getting an appointment sooner were even more important factors.”
The study results indicate that telemedicine for medical abortion is both effective, safe, and highly acceptable among women. “In rural areas in the United States, women may have to travel for hours to see a physician, and this can be an insurmountable barrier to care. Being able to meet with a doctor using telemedicine could help address disparities in access to health care and improve women’s health and well-being,” Grossman says.
Grossman D, Grindlay K, Buchacker T, Lane K, Blanchard K. Effectiveness and acceptability of medical abortion provided through telemedicine. Obstetrics and Gynecology. July 2011; 118(2):296-303.