Effectiveness, Safety, and Acceptability of No‐Test Medical Abortion Provided via Telemedicine: A National Cohort Study

Methods

Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.

Main Outcome Measures

Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability

Results

Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine‐hybrid model and more abortions were provided at ≤6 weeks’ gestation (40% vs. 25%, p<0.001). Treatment success (98.8% vs. 98.2%, p>0.999), serious adverse events (0.02% vs. 0.04%, p=0.557), and incidence of ectopic pregnancy (0.2% vs. 0.2%, p=0.796) were not different between models. In the telemedicine‐hybrid model, 0.04% were estimated to be over 10 weeks’ gestation at the time of the abortion; all were completed safely at home. Within the telemedicine‐hybrid model, effectiveness was higher with telemedicine than in‐person care (99.2% vs. 98.1%, p<0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.

Conclusions

A telemedicine‐hybrid model for medical abortion that includes no‐test telemedicine and treatment without an ultrasound is effective, safe, acceptable, and improves access to care.