Comparing telemedicine to in-clinic medication abortions induced with mifepristone and misoprostol

Objective

The objective was to compare the practical aspects of providing medication abortions through telemedicine and in-person clinic visits so that clinics can use this information when planning to add this service.

Study design

We conducted a comparative retrospective chart review comparing telemedicine medication abortions to a control group matched for date seen. We extracted and compared demographics, use of dating ultrasound, outcomes and unscheduled visits or communications with staff and physicians.

Results

During the study period, we provided 4340 medication abortions, of which 182 (4.2%) were provided through by telemedicine; 199 patients met the criteria to be in the control group. The mean age was 28.7 years for telemedicine patients and 28.1 years for in-person patients (p = .38). The mean gestational ages were also similar, 48.2 days for telemedicine patients and 46.5 days for in-person patients (p = .03). Only 33 (18.1%) of telemedicine patients had dating ultrasounds compared to 199 (100%) of in-clinic patients (p < .001). The proportions of documented completed abortions (164/182, 90.1% and 179/199, 89.9%, p = .76) were similar, as were the proportions of aspirations for completion (6/182, 3.3% and 9/199, 4.5%, p = .54) and the proportions lost to follow-up (5.5% and 6.6%, p = .66). There were 10 complications in each group (5.5% of telemedicine patients and 5.0% of in-clinic patients) (p > 0.5). Unscheduled communications with office assistants were greater in the telemedicine patients than the in-person patients (84/182, 46.2% vs. 43/199, 21.6% in-person, p < .001).

Conclusion

We found that telemedicine patients required more unscheduled communications and received ultrasounds far less often compared to in-clinic patients.

Implications

We could provide telemedicine without the need for ultrasound to most women. Larger studies without routine ultrasound use are needed to validate our findings. Unscheduled communication with clinic staff was more frequent with telemedicine medication abortion patients. This information may help clinics when planning to add this service.