Telehealth vs In-Clinic Medication Abortion Provision.

Abstract

Importance: In states that restrict abortion provision, residents rely on telehealth medication abortion (teleMAB) or travel out of state for in-clinic care; however, little is known about how patients using these modalities differ.

Objective: To compare characteristics of Kansas and Texas residents receiving teleMAB vs in-clinic medication abortion and to assess geographic and socioeconomic factors associated with modality of care.

Design, setting, and participants: This retrospective cross-sectional analysis used electronic medical record data for patients residing in Kansas or Texas who received medication abortion care from a teleMAB service or from an abortion facility in Kansas from February 1 to June 30, 2024. Patients younger than 18 years were excluded because only the telehealth site served this age group.

Exposure: Patient sociodemographic characteristics (age, race and ethnicity, and number of children), gestational age, and county-level distance to the nearest abortion facility, social vulnerability, and rural-urban designation.

Main outcomes and measures: The main outcome was receipt of teleMAB vs in-clinic care. Differences between patients who received teleMAB vs in-clinic care were assessed using χ2 and t tests for bivariate variables and multivariable logistic regression for adjusted comparisons.

Results: The teleMAB service served 12 823 patients (Texas: n = 12 552; Kansas: n = 271); the clinic served 725 patients (Texas: n = 587; Kansas: n = 138). Mean (SD) age was 26 (6) years for Kansas residents and 27 (6) years for Texas residents. In both states, more telehealth patients self-identified as Hispanic, Latino, Latina, or Latine (Texas: 3739 of 12 552 [32%]; Kansas: 48 of 271 [18%]) than in-clinic patients (Texas: 14 of 587 [3%]; Kansas: 8 of 138 [7%]) (P < .001). This difference remained among Texas residents after adjustment. In both states, compared with in-clinic patients, telehealth patients were more likely to be at less than 6 weeks' gestation (Texas: 7648 of 12 552 [61%] vs 155 of 587 [27%]; Kansas: 159 of 271 [59%] vs 45 of 138 [33%]; P < .001) and to have no children (Texas: 5545 of 12 552 [44%] vs 42 of 587 [7%]; Kansas: 137 of 271 [51%] vs 5 of 138 [4%]; P < .001). In Texas, patients who lived farthest from in-clinic care were more likely to receive telehealth than those who lived shorter distances (average marginal effect, 0.003; 95% CI, 0.002-0.004).

Conclusions and relevance: In this cross-sectional study of patients who used medication abortion, teleMAB patients more often had no children, were living farther from an abortion facility, and represented populations facing structural racism and long-documented barriers to abortion care compared with in-clinic patients, particularly in abortion-restrictive states. A higher number of patients at lower gestational age received telehealth than in-clinic services, suggesting more convenient and timely care.