Telehealth for Medication Abortion Worked as Well as In-Person Visit With Ultrasound

Medication abortion dispensed via mail after a history-based screening (no-test) during a telemedicine appointment yielded similar rates of abortion completion as an in-person appointment with ultrasonography, with few adverse events, according to a prospective observational study.

In adjusted analyses, medication abortion was effective for 94.4% of the no-test-plus-mail group and 93.3% for the in-person group with ultrasonography, meeting criteria for non-inferiority, reported Lauren Ralph, PhD, MPH, of Advancing New Standards in Reproductive Health (ANSIRH) at the University of California San Francisco, and colleagues.

A third arm of the nonrandomized study also showed that medication abortion was 95% effective for the group receiving no-test screening (either virtually or in person) with pickup of medications, the study in JAMA showed.

Rates of serious adverse events were similar, at 1.5% for the telehealth-plus-mail group and 1.4% for the in-person group with ultrasonography, with none in the no-test-plus-pickup group.

“I think that our study is actually really consistent with the research that has been coming out in recent months and years. And I think that’s a good thing,” Ralph told MedPage Today.

For instance, earlier this year, ANSIRH’s prospective CHAT trial found that medication abortion via telemedicine was safe and effective, and another ANSIRH study from last month revealed that patients found mail-order medication acceptable.

Ralph also noted that in the current context of increasing abortion restrictions, the ways people seek abortion care are changing.

“We have this sort of increased demand for models of abortion, and medication abortion specifically, that maintain access or ensure access for those that now live hundreds of miles from an abortion facility, and for those for whom travel for abortion is a significant barrier to care,” she said.

Melissa Simon, MD, an ob/gyn at Northwestern Medicine in Chicago and director of the Center for Health Equity Transformation, who was not involved in the research, told MedPage Today that the study “helps support the high-quality evidence underscoring the safety and effectiveness of medication abortion provided using a no-test telehealth screening for eligibility and a mail delivery method to dispense the medications.”

She also noted this evidence is important in the context of ongoing attacks on medication abortion. That includes the Supreme Court case FDA v. the Alliance for Hippocratic Medicine, which challenged the FDA’s two-decade-old approval of mifepristone based on the quality of evidence the FDA used at the time — though the Court unanimously ruled that the plaintiffs didn’t have standing.

The current study, conducted from May 2021 through March 2023, compared abortion effectiveness among three groups: those assessed virtually and dispensed medications via mail; those assessed either virtually or in person who picked up their medications in-person; and those who had an in-person visit with ultrasonography and received their medications in person.

A total of 585 participants were included. They were from Colorado, Illinois, Maryland, Minnesota, Virginia, and Washington. They had a mean age of 27.3 years, and the median gestational duration was 45 days. Overall, 48.6% were non-Hispanic White and 28.1% were non-Hispanic Black.

Participants filled out electronic surveys at 1 day, 2 weeks, and 1 month after receiving abortion medications. Outcome data were known for 91.8% of participants.

Serious adverse events occurred in 1.1% of patients and included overnight hospitalization in four, blood transfusion in two, and emergency surgery in one patient. Three such events occurred in the no-test-plus-mail group and three occurred in the in-person group.

The study had several limitations, including the fact that 8% of participants were lost to follow-up, and that they only collected patient outcomes up to 4 weeks after treatment began. Also, because patients could select their model of medication abortion care, there were slight differences among groups.

Ralph said in the future, the team is interested in exploring whether the no-test-plus-mail model is preferred by patients.

She and her team concluded that the findings “indicate that no-test and telehealth models with mailing of medications may be offered as an option to people seeking abortion.”

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