Study findings offer roadmap for medication abortions

Currently most abortion pills are dispensed by independent reproductive health clinics, said the paper's senior author.

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A study of clinics' and primary care doctors' means of dispensing abortion medications during the pandemic may offer clinicians guidance for doing so in a post-Roe world.

The study, published today in the Annals of Family Medicine, examined services provided by family medicine clinicians in varied settings: family planning clinics, online medical services, and primary care practices, both within and outside of multispecialty healthcare systems.

Currently, most abortion pills — a combination of two medications, mifepristone and misoprostol — are dispensed by independent reproductive health clinics, said the study's senior author, Dr. Emily Godfrey, an OB-GYN and a family medicine physician with the UW Medicine healthcare system in Seattle.

With increasing restrictions on access to abortion care, the study provides “a roadmap for primary care and OB-GYN clinicians to rapidly initiate telemedicine abortion for patients, where the law allows,” Godfrey said. 

Across all practice settings, the investigators found similar operational procedures for remote medication abortion services, with each site following five basic steps for care provision: patient engagement, care consultations, payment, medication dispensing, and follow-up communication, noted lead author Anna Fiastro, research manager of the University of Washington School of Medicine Family Planning division.

The asynchronous method of patient-provider communication (online via email, text or an electronic medical record portal) usually took two to three minutes of the clinician’s time, versus a video call that took 10 to 30 minutes, the study reported. Regardless of the healthcare setting, the medications were delivered to the patient via U.S. Postal Service to the patient’s home or selected address. Follow-up communication between the patient and clinician was, in all cases, optional and often patient-initiated, either by phone call, video conferencing or texts and emails.

In all, the research team interviewed 21 doctors or clinic staff in various states, including Washington, in November and December of 2020. The clinicians interviewed were mostly family physicians or family nurse practitioners from 15 sites, the report noted.

The study occurred before the June decision by the U.S.  Supreme Court that overturned Roe versus Wade and the constitutional protection of an abortion.  As states ban abortion care, healthcare providers will continue to meet patients' needs for comprehensive reproductive healthcare services in states where abortion remains legal and available, the authors noted.

Results from this study have contributed to the Access, Delivered Provider Toolkit, a step-by-step guide for providers interested in initiating their own telemedicine abortion services. Next steps for the group include understanding patients' experience with telehealth medication abortions services — specifically patient perceptions of these service models and how telehealth abortion may improve access to care for those traditionally marginalized by healthcare systems.

This is one of several studies Godfrey has led on medication abortion, including two last year that evaluated demand and aftercare for patients. In those studies, researchers found that clinics that mailed mifepristone and misoprostol pills to patients during the pandemic experienced high demand for telehealth abortion services and were able to safely screen and care for patients.

Mifepristone and misoprostol have been approved by the U.S. Food and Drug Administration and can be used safely and effectively to end an early pregnancy. The agency in December lifted longstanding restrictions on mifepristone, allowing doctors to prescribe the medication after a telehealth visit and send them to patients by mail or via mail-order pharmacy.  Medication abortions now account for over half of the abortions in the United States.

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