Study: Telemedicine provision of medication abortion in Alaska helps women access care earlier in pregnancy

August 2016

A new study in the Journal of Telemedicine and Telecare found that telemedicine provision of the abortion pill (medication abortion) in Alaska facilitated a more patient-centered approach to care, allowing women to access services sooner in pregnancy, have greater choice in abortion procedure type, and be seen closer to home.

These findings from researchers based at Ibis and Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco (UCSF) build on other studies examining the safety, effectiveness, acceptability and impact of telemedicine provision of abortion services. Despite the evidence that this provision model is safe, effective, and well-liked by women and reduces later abortion, 18 states have banned the use of telemedicine for abortion.

“This study adds to the robust evidence base that has clearly documented both the acceptability and large potential benefits of telemedicine provision of medication abortion,” said Kate Grindlay, lead author on the study and associate  at Ibis. “Our results were in line with other research that has shown that this service can be easily integrated into other health care offered at a clinic, can help women access the services they want and need closer to home, and allows providers to offer high-level care to women from a distance.”

The researchers evaluated providers’ experiences with offering medication abortion via telemedicine, which involves using information and communication technology, such as a secure video chat, to provide health care at a distance. Research results indicate that the introduction of telemedicine resulted in women having greater choice in type of abortion procedure. Prior to the introduction of telemedicine services, a physician in Alaska might only visit certain facilities one or two times per month, meaning that women could have to wait weeks for an appointment. This wait time could put women outside of the gestational age eligibility window for a medication abortion. Many participants felt that prior to telemedicine, women did not always have a ‘real’ choice because of the time-sensitive nature of medication abortion.

Though study participants largely said they did not see an impact on the numbers of abortions provided, they reported that women were able to receive abortion care earlier in pregnancy and that the proportion of medication abortion increased, reflecting the improvement in patient options.

“This study reinforces that medication abortion provided via telemedicine is an important option for women, particularly in rural areas,” said Dr. Daniel Grossman, one of the authors of the study, director of ANSIRH, and professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at UCSF. “Our previous research found that telemedicine provision of medication abortion is equally as safe and effective as when the service is offered with an in-person visit, and in Iowa, its introduction was associated with a reduction in second-trimester abortion. This most recent paper suggests that this model of care will improve access to early abortion in Alaska as well, and we look forward to studying this in more depth in the coming years.”

Study participants reported that the greatest impact after telemedicine introduction was on patients, expressing that the most significant gain was that clinics could schedule appointments on additional days and times that better meet patients’ needs and in turn allow women to be seen at earliest gestational ages. Results also showed that providers felt it was easy to integrate technology into clinic operations, and that telemedicine provision largely required the same overall processes, clinic flow, and physician role and interaction as in-person visits. Patient experiences were perceived to be positive, and all respondents stated that they would recommend and support expanding telemedicine to new clinics, types of medicine, and geographic locations.

To learn more about Ibis's work on telemedicine provision of medication abortion, visit the project page.