Medication abortion via digital health in the United States: a systematic scoping review

Test or No-Test: Comparison of Medication Abortion Outcomes and Adverse Events When Forgoing Ultrasound, Laboratory Testing, and Physical Examination

OBJECTIVES

This study aimed to compare demographics and clinical outcomes between patients who did not undergo investigations and those who underwent investigations before receiving a prescription for medication abortion (MA) during the first 6 months of the COVID-19 pandemic. Outcomes include success rates, adverse events, pathways to completion, and loss to follow-up rates.

METHODS

We conducted a retrospective medical record review of 1452 patients presenting for MA between 23 March 2020 and 30 September 2020. Descriptive statistics, 2 × 2 chi-square tests, and Fisher exact tests were used to compare characteristics and outcomes between groups.

RESULTS

Of the 1307 patients who received a prescription, 895 (68.5%) were in the no-test group and 412 (31.5%) were in the test group. The success rate was 95.2%, with no significant difference between groups (94.0% and 95.8%, P = 0.194). Rates of adverse events were low, with 28 patients presenting for emergency department visits (2.1%), 62 having clinically significant retained products of conception (4.7%), 5 with heavy bleeding requiring treatment (0.4%), 16 with ongoing pregnancy (1.2%), and 3 requiring ectopic pregnancy management (0.2%). Completion of abortion was verified in 1034 patients (80.5%), and the loss to follow-up rate was 22.6%, with no difference between the groups (82.1% vs. 79.8%, P = 0.341; and 21.4% vs. 23.1%, P = 0.477; respectively).

CONCLUSIONS

We found that clinical outcomes were consistent across the 2 groups, with high success rates and low adverse event rates. Our study contributes to the growing body of evidence that allows for individualized care implementing selective use of low- and no-test MA protocols.

Effectiveness and safety of medication abortion via telemedicine versus in-person: A cohort of pregnant people in Colombia

OBJECTIVE

To compare the effectiveness and safety of medication abortion (MAB) via telemedicine versus in-person in pregnant people with less than 12 gestational weeks in Colombia.

STUDY DESIGN

A retrospective cohort study was conducted with 23,362 pregnant people who requested MAB service from Profamilia (a Colombian non-governmental organization) in 2021-2022. The outcomes were success and safety of MAB. We performed a descriptive and a multivariate statistical analysis using the binary regression model to obtain an adjusted Odds Ratio (aOR) to identify factors associated with abortion success.

RESULTS

In comparison to in-person care (n = 20,289), individuals in telemedicine (n = 3073) were predominantly from urban areas, belonged to a lower socioeconomic stratum, single and did not identify with any ethnic group. In-person users tended to have higher levels of education and accessed the service through private insurance (p < 0,05). There were no differences in the odd of a successful abortion based on the modality of care (aOR 1.18; 95% CI=0.87-1.59). The results were also the same with sensitivity analysis stratified: pregnant people who were nine weeks gestation or less (aOR 0.86; 95% CI=0.63-1.17) or more (aOR 0.87; 95% CI=0.28-2.65).

CONCLUSION

Telemedicine is an effective and safe option for MAB, as in-person care. Telemedicine has the potential to increase abortion access by extending the availability of providers and offering people a new option for obtaining care conveniently and privately, especially for women with disadvantaged socioeconomic and educational background.

IMPLICATIONS

This study demonstrates that medication abortion (MAB) administered via telemedicine produces outcomes akin to those of in-person care, providing a compelling rationale for its adoption, particularly in underserved regions. This approach can be replicated in other countries in Latin America and the Caribbean.