December 2020

Introduction of telemedicine for medication abortion: Changes in service delivery patterns in two US states

Kohn J, Snow J, Grossman D, Thompson T-A, Seymour J, Simons H. Introduction of telemedicine for medication abortion: Changes in service delivery patterns in two US states. Contraception. December 2020. DOI: 10.1016/j.contraception.2020.12.005

Objective(s): Telemedicine for medication abortion (teleMAB) is safe and effective, yet little is known about how its introduction affects service delivery. We assessed changes in service delivery patterns 1 year after introducing teleMAB at Planned Parenthood in 2 U.S. states.

Study design: Retrospective records analysis using electronic health record data from Planned Parenthood health centers in Montana and Nevada from 2015 to 2018. We included all patients receiving medication or aspiration abortion in the year before and after introducing site-to-site teleMAB. Outcomes included: the proportion of medication abortions (vs. aspiration); gestational age at abortion; time to appointment; and distance traveled. We compared outcomes pre- and postimplementation using χ2, t tests, and Mann-Whitney U tests.

Results: We analyzed data for 3,038 abortions: 1,314 pre- and 1,724 postimplementation. In Montana, the proportion of medication abortions increased postimplementation (60% vs. 65%, p = 0.04). Mean gestational age was similar: 58 versus 57 days (p = 0.35). Mean time to appointment decreased (14 vs. 12 days, p < 0.0001), as did one-way distance traveled by patients (134 vs. 115 miles, p = 0.03). In Nevada, where Planned Parenthood only provided medication abortion, total medication abortions increased (461 vs. 735). Mean gestational age remained stable (51 vs. 51 days, p = 0.33), as did time to appointment (8 vs. 8 days, p = 0.76). Mean one-way distance traveled was 47 miles in the preperiod versus 34 miles in the postperiod (p = 0.22).

Conclusion(s): Medication abortion increased after the introduction of telemedicine in both states, though we cannot account for abortions performed by other providers. Telemedicine has the potential to improve access to medication abortion.

Implications: Telemedicine has the potential to improve or maintain access to medication abortion and should be taken to scale where feasible. Continued efforts are needed to mitigate or reverse policy restrictions on telemedicine for medication abortion.