番茄社区

The safety of medical abortion via telemedicine was comparable to safety of an in-person medical abortion, a retrospective cohort study found.

There was no difference in the prevalence of clinically significant adverse events with abortion administered via telemedicine versus in-person abortion (0.18% versus 0.32%, respectively), reported Daniel Grossman, MD, of the University of California San Francisco, and Kate Grindlay, MSPH, of Ibis Reproductive Health in Cambridge, Calif.

And there were no deaths or surgeries required for any patients following a medical abortion in a survey of local hospitals, the authors wrote in .

For telemedicine abortion, a patient was evaluated by clinic staff without a physician on site, and her records were then evaluated by an off-site physician. The physician had a video discussion with the patient to determine her eligibility for medical abortion, and then mifepristone and misoprostol were remotely dispensed, the authors said. Patients receive "routine counseling" and follow-up, and were contacted if they did not return to follow-up.

They noted that Planned Parenthood of the Heartland in Iowa began offering medical abortion via telemedicine in 2008. also found that some measures of patient satisfaction were higher with telemedicine than in-person.

Jessica Atrio, MD, of Montefiore Hospital and Albert Einstein College of Medicine in New York City, who was not involved with the research, characterized this as "superb research" with "extremely reassuring" data.

"Medicine has begun to navigate how telemedicine will shape and impact our provision of medical care," she told 番茄社区. "This research demonstrates that telemedicine has the potential to sustain and augment our ability to meet women's crucial reproductive health needs, even in remote settings where physicians are unable to be physically present."

Grossman and Grindlay examined clinically significant adverse events from July 2008 to June 2015 at Planned Parenthood of the Heartland clinics, including five in-person medical abortion sites and at most 13 that offered telemedicine services.

Clinically significant adverse events were defined as hospital admission, surgery (not including vacuum aspiration of the uterus), blood transfusion, and death, as well as treatment in an emergency department, such as a patient requiring intravenous fluids or oral medication.

Researchers used data from the Planned Parenthood clinic system's practice management database, with adverse events derived from reporting forms submitted to the mifepristone distributor.

Grossman and Grindlay also surveyed 119 emergency departments in Iowa asking if they had treated a woman with an adverse event following a medical abortion this year. Forty-two emergency departments responded to this survey.

Of the 8,765 medical abortions performed with telemedicine and 10,405 medical abortions performed with an in-person clinic visit, there were 49 clinically significant adverse events. The authors said that the 0.13% difference (95% CI -0.01 to 0.28%, P=0.07) in adverse event prevalence was "within our margin of non-inferiority."

In addition, 34 emergency departments reported that no women had presented with a possible complication from medical abortion in the prior year, and eight were not sure.

Grossman and Grindlay said that in the two years after telemedicine was introduced at this clinic, women had almost a 50% higher adjusted odds of versus a second-trimester abortion compared to the two years prior.

But they added that while the Iowa Supreme Court a restriction the state passed prohibiting the use of technology, 18 other states have prohibiting the use of telemedicine to provide medical abortion.

Atrio noted that nearly a third of the more rural and remote regions of the country do not have adequate access to obstetric and gynecologic care.

"We will need to continue to apply technology and innovative practices to provide women in these regions access to quality healthcare," she said.

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