ELIGIBILITY FOR MEDICATION ABORTION WITH ASYNCHRONOUS SCREENING VS. IN-PERSON CARE

Abstract

Objectives

Asynchronous, no-test screening for medication abortion has recently expanded rapidly. However, there is minimal evidence on how asynchronous clinician assessment of medication abortion eligibility using patient-reported health history and symptoms compares with eligibility determined through synchronous, in-person care.

Methods

We recruited patients seeking in-person medication abortion at five facilities in three US states from July to December 2024. Before their appointment, participants completed a survey on medication abortion eligibility criteria; their responses were blinded and reviewed asynchronously by an onsite clinician who assessed eligibility. Participants then proceeded with routine care, and we abstracted clinical encounter data. We examine concordance between clinician asynchronous review of patient self-reported eligibility and in-person clinical encounter.

Results

Of 260 approached, 172 enrolled and 146 met the criteria to have clinicians review survey responses. Overall, 112 (77%) were eligible for medication abortion on clinician review of survey responses; reasons for ineligibility were gestational duration (n=17), ectopic concern (n=15), and another contraindication (n=4). During the clinical encounter, 90% (n=132) were eligible for medication abortion; reasons for ineligibility were negative pregnancy test/miscarriage (n=8), gestational duration (n=5), ectopic concern (n=1) and another contraindication (n=1). Concordance on eligibility between clinician review of patient-reported survey responses and clinical encounter was 114/146 (78%). Six cases were eligible on clinician review but deemed ineligible during clinical encounter (3 gestational duration; 3 not pregnant). Twenty-six were ineligible on clinician review but deemed eligible on clinical encounter.

Conclusions

Results suggest current asynchronous, no-test screening for medication abortion is conservative, and results in more people screening out of no-test care vs. being given medications when medication abortion is contraindicated.