Use of an at-home multilevel pregnancy test and an automated call-in system to follow-up the outcome of medical abortion

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

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Self-Assessment at Home Is Feasible for Follow-up Of Medical Abortion

International Perspectives on Sexual and Reproductive Health ◽

10.1363/intsexrephea.41.3.168 ◽

2015 ◽

Vol 41 (3) ◽

pp. 168

Keyword(s):

Medical Abortion ◽

Self Assessment ◽

At Home

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Simplified medical abortion using a semi-quantitative pregnancy test for home-based follow-up

International Journal of Gynecology & Obstetrics ◽

10.1016/j.ijgo.2012.11.022 ◽

2013 ◽

Vol 121 (2) ◽

pp. 144-148 ◽

Cited By ~ 25

Author(s):

Kelsey Lynd ◽

Jennifer Blum ◽

Nguyen Thi Nhu Ngoc ◽

Tara Shochet ◽

Paul D. Blumenthal ◽

...

Keyword(s):

Medical Abortion ◽

Pregnancy Test ◽

Home Based

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Adherence to treatment and prevalence of side effects when medical abortion is delivered via telemedicine

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2021-201263 ◽

2021 ◽

pp. bmjsrh-2021-201263

Author(s):

John Joseph Reynolds-Wright ◽

Anne Johnstone ◽

Karen McCabe ◽

Emily Evans ◽

Sharon Cameron

Keyword(s):

Side Effects ◽

Medical Abortion ◽

Drug Regimen ◽

Telephone Consultation ◽

Pain Scores ◽

Telemedicine Consultation ◽

Gastrointestinal Side Effects ◽

Scottish Government ◽

At Home

BackgroundThe Scottish government introduced legislation during the COVID-19 outbreak to permit medical abortion at home with telemedicine. All women received an initial telephone consultation. For those choosing medical abortion, we provided self-administered medications to eligible women with pregnancies under 12 weeks’ gestation.AimsTo assess adherence to the recommended abortion drug regimen, with particular focus on the number of misoprostol doses used and the interval between mifepristone and misoprostol administration and the induction–expulsion interval. Additionally, to evaluate use of analgesia, antiemetics and antibiotics, and the side effects, pain and bleeding profile of medical abortion at home.MethodsWe conducted a prospective cohort study of 663 women choosing medical abortion at home via telemedicine at an NHS abortion service in Edinburgh, Scotland between 1 April and 9 July 2020. Interviewer-administered questionnaires were completed at telephone follow-up 4 and 14 days following treatment. Outcome measures were self-reported and included use of mifepristone and misoprostol, induction–expulsion interval (time from misoprostol administration until expulsion of pregnancy), antiemetics, antibiotics, analgesia use, pain scores, rates of side effects, bleeding and preparedness for treatment.ResultsAmong the respondents, 652/663 women (98%) answered at least one questionnaire, and 594/663 (89.6%) used both abortion medications as directed (24–72 hours between medications). The mean (SD) induction–expulsion interval was 4.3 (4.3) hours. Antiemetics were used by 611/663 (92%), 383/599 (64%) completed the course of prophylactic antibiotics, and 616/663 (93%) used analgesia, with mean (SD) worst-pain scores of 6.7 (2.2) out of 10. Regarding side effects, 510/663 (77%) experienced either nausea, vomiting, diarrhoea or headache, 101/663 (15%) experienced headache and 510/663 (77%) experienced bleeding that was heavier than a period; 554/663, (84%) felt prepared for their treatment by teleconsultation.ConclusionPatients are able to correctly self-administer abortion medications following a telemedicine consultation. Further research is required to optimise pain management and gastrointestinal side effects during medical abortion.

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Can a multilevel pregnancy test (MLPT) be used for medical abortion follow-up among women at more than 63 days’ gestation? Evidence from prenatal hCG data

Contraception ◽

10.1016/j.contraception.2017.07.033 ◽

2017 ◽

Vol 96 (4) ◽

pp. 269

Author(s):

T Shochet ◽

K Lerma ◽

J Blum ◽

WR Sheldon ◽

PD Blumenthal ◽

...

Keyword(s):

Medical Abortion ◽

Pregnancy Test

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Early medical abortion using telemedicine – acceptability to patients

10.1101/2020.11.11.20229377 ◽

2020 ◽

Cited By ~ 1

Author(s):

Chelsey Porter Erlank ◽

Jonathan Lord ◽

Kathryn Church

Keyword(s):

Service Providers ◽

Medical Abortion ◽

List Type ◽

Check Sample ◽

High Confidence ◽

High Satisfaction ◽

First Choice ◽

Patient Reported ◽

At Home

ABSTRACTIntroductionThe English government approved both stages of early medical abortion (EMA) for at-home use on 30th March 2020. MSI Reproductive Choices UK (MSUK), one of the largest service providers of abortion services in England, launched a telemedicine EMA pathway on 6th April 2020.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. 1,243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within five days post-procedure. Responses were analysed quantitatively and descriptively. The sample was compared to the total telemedicine EMA population on nine sets of background characteristics to check sample validity, and all results were tested across the same nine characteristics for variation.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. No patient reported that they were unable to consult privately. Over 80% of patients reported preferring the telemedicine pathway, and two-thirds that they would choose telemedicine again if COVID-19 were no longer an issue.DiscussionTelemedicine EMA is a valued, private, convenient and easier option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make access to telemedicine EMA permanent.Key message pointsOn 30th March 2020, the English government approved both stages of early medical abortion (EMA) for at-home use, paving the way for telemedicine EMA provision.MSUK patients receiving routine follow-up calls reported high confidence in telemedicine EMA and high satisfaction with the privacy, convenience and ease of this pathway.Two-thirds of telemedicine EMA patients reported they would choose this pathway again in future, demonstrating that it should remain available after the COVID-19 pandemic.

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