Patients favor telehealth for medication abortion consults

In a study, patients reported overall satisfaction, but those who came to clinical facilities said the visits were lengthy and lacking comfort.

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Patients seeking medication abortion care through telehealth services are just as satisfied, if not more so, with the service they received as patients who visited a clinical facility to receive care, according to a study published this month in Obstetrics & Gynecology.

The study involved 30 patients who sought medication abortion in Washington state from September 2021 to January 2022. Researchers found that the 20 patients who used telehealth to receive the pills for a medication abortion reported feeling more relaxed during their clinical encounters.

Even though they reported overall satisfaction with their care, the 10 who received care in a clinic facility portrayed their consultations as lengthy, chaotic and lacking comfort, the published paper said.

“I listened to all the interviews, and telehealth patients felt very positive about the care,” said lead author Dr. Emily Godfrey, a UW Medicine OB-GYN and family medicine doctor. “That’s because they didn’t have to struggle with transportation, which is a huge benefit. They could have the appointment, live with videos during their lunch hour or in their car, or in a private space at a friend’s home."

Both groups reported high satisfaction reported with their clinical experiences. In-person patients reported that they relied heavily on printed material for guidance, while online patients relied more on advice during the visit and online information about medication abortion.

This study focused on the patients' view of their interactions with providers, without distinguishing whether the care professional was a doctor or nurse practitioner. Patient-provider interactions are important to evaluate because they are associated with patient trust, treatment adherence, patient experience, healthcare efficiency and cost, the study noted.

Interviewees were 20 to 38 years old.  Average gestational age at time of the visit was about seven weeks, according to the study.  

In the United States, more than more than half of all abortions are now medication abortion; in Washington state, that figure is just under 60%.

The rate of telemedicine visits for medication abortion increased in 2019 when the Food and Drug Administration rolled back the in-clinic rules because of the COVID-19 pandemic. Since the U.S. Supreme Court overturned Roe vs. Wade in the Dobbs decision last June, the use of telemedicine for medication abortion services has increased by 137%, according to the Society of Family Planning WeCount study.

Patients who participated in the study were from the Cedar River Clinic in Renton, as well as sites in Yakima and Tacoma.  More patients seeking telemedicine consults had undergone a prior abortion and tended to live outside the metro areas, compared with in-person patients, Godfrey said.

Soon, an expanded study with data from almost 2,000 patients will more fully illustrate the sociodemographics of patients receiving telemedicine versus in-person medication abortion care, Godfrey noted. Another forthcoming study will examine the decision-making process of why patients chose to travel to the clinic or pursue a telemedicine visit.

“Generally those who were younger or may have had a medical condition were more likely to choose an in-clinic visit,” Godfrey said. She added that patients, during an initial interview, who did not know the date of their last period or who might have been experiencing conditions like an ectopic pregnancy were booked for an in-clinic visit and not included in this study.

Next week, the 5th U.S. Circuit Court of Appeals will consider a reinstatement of the in-person clinic requirement for patients to obtain abortion pills, among other restrictions. 

“Such a move would be harmful for patients in light of previous evidence about travel to clinics being a barrier to medical access — and now, coupled with this study suggesting that patients can receive quality, patient-centered care via telemedicine,” Godfrey said.

In general, the study shows that telemedicine abortion can be provided using high-quality patient-provider communication, considered a critical element of patient-centered care.

“Patient-centered care is essential to improving healthcare delivery and helping the nation achieve its goals of providing the best possible care to everyone, and especially those populations in rural settings or with difficulties reaching medical clinics,” she said.  

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