Study supports telehealth model for medication abortion

Women who had telemedicine access to a trusted primary-care provider and received a prescription for medication abortion described the experience as “easy,” “safe” and “convenient,” according to research published this week in the Annals of Family Medicine.

The qualitative study of 14 people in a Massachusetts health system found that having access to medication abortion pills via their primary care provider, versus through a clinic outside of their system, was a positive and easy experience. 

“I think the big takeaway is that primary care can absolutely do telemedicine and provide medication abortion,” said Dr. Emily Godfrey, the paper’s senior author and a family medicine and OB-GYN physician with UW Medicine in Seattle.

Godfrey noted that because “no one expects to have an unplanned pregnancy,” the ability to navigate within a familiar healthcare system reduces the stress of seeking abortion care.  When medication abortion is included among the services offered in primary care, it normalizes abortion care within the healthcare system, she said. 

“I think our study really highlights that many patients were seen throughout prior pregnancies in their primary-care system and appreciated being able to see the same doctors in the same system for their abortion care. It made them feel more comfortable with the process,” said co-author Anna Fiastro, a researcher in the UW School of Medicine’s Department of Family Medicine. 

The team interviewed 14 patients who had received a medication abortion prescription via telemedicine within a safety-net clinic and hospital health system between July 2020 and December 2021. The languages the patients spoke included English, Spanish and Portuguese. 

Participants reported receiving telemedicine medication abortion services in their primary-care health system as acceptable, positive, and easy to use. Participants discussed how this method of service supported their ability to exercise control over their care, autonomy, and flexibility with completing care while still managing their other responsibilities. They described fewer barriers than when accessing in-person clinic care, authors reported.

Many participants perceived their primary-care health system as the place to go for any pregnancy-related healthcare need, including abortion, the authors noted. The patients also valued receiving abortion care from their established healthcare team even more within the context of their ongoing social and medical concerns, authors noted.

Relatively few hospital systems include abortion services within primary care. At the time of the study, only two U.S. healthcare systems practiced this model, Godfrey noted. She and the co-authors hope that other primary-care systems will adopt the Massachusetts model to decrease silos of care, to normalize abortion care as part of primary care, and to improve access to medication abortion. The system in which this study was conducted has many patients who identify as immigrants. Among them 42% have limited English proficiency requiring professional medical interpretation in over 60 languages, and the majority hold public or subsidized insurance.

Both Godfrey and Fiastro stress that this recommendation is being made to states where telemedicine, abortion medications, and abortion remain legal. Currently such a care delivery model is operating at UW Medicine, which began its telemedicine-medication abortion services last June. 

The authors acknowledged that the study size was small, and encouraged a larger, more diverse study to look at the socioeconomics and demographics of women seeking telemedicine medication abortion. 

For details about UW Medicine, please visit http://uwmedicine.org/about.