An observational study of patient experiences with a direct-to-patient telehealth abortion model in Australia

BackgroundWhile abortion care is widely legal in Australia, access to care is often poor. Many Australians must travel long distances or interstate to access abortion care, while others face stigma when seeking care. Telehealth-at-home medical abortion is a potential solution to these challenges. In this study, we compared the experience of accessing an abortion via telehealth-at-home to accessing care in-clinic.MethodsOver a 20-month period, we surveyed patients who received medical abortion services at Marie Stopes Australia via the telehealth-at-home service or in-clinic. We conducted bivariate analyses to assess differences in reported acceptability and accessibility by delivery model.ResultsIn total, 389 patients were included in the study: 216 who received medical abortion services in-clinic and 173 through the telehealth-at-home service. Telehealth-at-home and in-clinic patients reported similarly high levels of acceptability: satisfaction with the service (82% vs 82%), provider interaction (93% vs 84%), and recommending the service to a friend (73% vs 72%). Only 1% of telehealth-at-home patients reported that they would have preferred to be in the same room as the provider. While median time between discovering the pregnancy to first contact with a clinic was similar between groups, median time from first contact to taking the first abortion medication was 7 days longer for telehealth-at-home patients versus in-clinic patients (14 days (IQR 9–21) vs 7 days (IQR 4–14); p<0.01).ConclusionThe telehealth-at-home medical abortion service has the potential to address some of the challenges with provision of abortion care in Australia.

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At-home telemedicine for medical abortion in Australia: a qualitative study of patient experiences and recommendations

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200612 ◽

2020 ◽

Vol 46 (3) ◽

pp. 172-176 ◽

Cited By ~ 4

Author(s):

Laura Fix ◽

Jane W Seymour ◽

Monisha Vaid Sandhu ◽

Catriona Melville ◽

Danielle Mazza ◽

...

Keyword(s):

Patient Care ◽

Medical Abortion ◽

Home Delivery ◽

Patient Experiences ◽

Provider Education ◽

Telemedicine Service ◽

Convenience Sample ◽

Patient Reports ◽

Legal Contexts ◽

At Home

IntroductionThis study aimed to explore patient experiences obtaining a medical abortion using an at-home telemedicine service operated by Marie Stopes Australia.MethodsFrom July to October 2017, we conducted semistructured in-depth telephone interviews with a convenience sample of medical abortion patients from Marie Stopes Australia. We analysed interview data for themes relating to patient experiences prior to service initiation, during an at-home telemedicine medical abortion visit, and after completing the medical abortion.ResultsWe interviewed 24 patients who obtained care via the at-home telemedicine medical abortion service. Patients selected at-home telemedicine due to convenience, ability to remain at home and manage personal responsibilities, and desires for privacy. A few telemedicine patients reported that a lack of general practitioner knowledge of abortion services impeded their access to care. Most telemedicine patients felt at-home telemedicine was of equal or superior privacy to in-person care and nearly all felt comfortable during the telemedicine visit. Most were satisfied with the home delivery of the abortion medications and would recommend the service.ConclusionPatient reports suggest that an at-home telemedicine model for medical abortion is a convenient and acceptable mode of service delivery that may reduce patient travel and out-of-pocket costs. Additional provider education about this model may be necessary in order to improve continuity of patient care. Further study of the impacts of this model on patients is needed to inform patient care and determine whether such a model is appropriate for similar geographical and legal contexts.

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Why Women Choose At-Home Abortion via Teleconsultation in France?: A Mixed-Method Study on Drivers of Telemedicine Abortion

10.1101/2021.04.19.21255757 ◽

2021 ◽

Author(s):

Hazal Atay ◽

Helene Perivier ◽

Kristina Gemzell-Danielson ◽

Jean Guilleminot ◽

Danielle Hassoun ◽

...

Keyword(s):

Mixed Method ◽

Public Involvement ◽

Medical Abortion ◽

Patient And Public Involvement ◽

Mixed Method Study ◽

List Type ◽

Cross Sectional ◽

Safe Abortion ◽

Abortion Care ◽

At Home

AbstractObjectivesIn face of the COVID-19 health emergency, France has allowed medical abortions to be performed by teleconsultation until 9 weeks of gestation. In an attempt to understand the demand and main drivers of telemedicine abortion, we analysed the requests that Women on Web (WoW), an online telemedicine abortion service operating worldwide, received from France throughout 2020.MethodsWe conducted a parallel convergent mixed-method study among 809 consultations received from France at WoW between 1 January and 31 December 2020. We performed a cross-sectional study of data obtained from the WoW consultation survey and a manifest content analysis of anonymised email correspondence of 140 women consulting with WoW helpdesk from France.ResultsWe found that women encounter macro-level, individual-level, and provider-level constraints while trying to access abortion in France. The preferences and needs over secrecy (46.2%), privacy (38.3%), and comfort (34.9%) are among the most frequent reasons for women from France to choose telemedicine abortion through WoW. The COVID-19 pandemic seems to be an important driver for resorting to telemedicine (30.6%). The lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.ConclusionsThe demand for at-home medical abortion via teleconsultation increased in France during the lockdowns. However, drivers of telemedicine abortion are multi-dimensional and go beyond the conditions unique to the pandemic. Given the various constraints women continue to encounter in accessing safe abortion, telemedicine can help meet women’s preferences and needs for secrecy, privacy and comfort, while facilitating improved access to and enabling more person-centred abortion care.Tweetable AbstractAt-home abortion via teleconsultation can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating improved access to abortion care in France.Key MessagesThe lockdowns seem to have had an impact on the number of consultations received at WoW from France, increasing from 60 in March to 128 in April during the first lockdown and from 54 in October to 80 in November during the second lockdown.While the COVID-19 pandemic was an important push factor for women to choose telemedicine, the drivers of telemedicine are multidimensional and go beyond conditions unique to the pandemic.Telemedicine can help meet women’s needs and preferences for privacy, secrecy, and comfort, while facilitating access to and enabling more person-centred abortion care in France.Funding InformationThis research was funded by a public grant overseen by the French National Research Agency (ANR) as part of the “Investissements d’Avenir” program LIEPP (ANR-11-LABX-0091, ANR-11-IDEX-0005-02) and the Université de Paris IdEx (ANR-18-IDEX-0001).Patient and public involvement statementThis public policy analysis does not involve patients or the public in the design, or conduct, or reporting, or dissemination plans of this work. However, the service that WoW provides is designed to address the priorities and experiences of people who access the service. Thus, the research questions were informed by the needs of people who rely on WoW to access abortion.Ethics approvalThe study was approved by the Regional Ethics Committee, Karolinska Institutet, Dnr 2009/2072-31/2 and Dnr 2020/05406.

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Effectiveness, safety and acceptability of no-test medical abortion provided via telemedicine: a national cohort study

10.1101/2020.12.06.20244921 ◽

2020 ◽

Author(s):

Abigail Aiken ◽

Patricia A Lohr ◽

Jonathan Lord ◽

Nabanita Ghosh ◽

Jennifer Starling

Keyword(s):

Cohort Study ◽

Adverse Events ◽

Access To Care ◽

Ectopic Pregnancy ◽

Medical Abortion ◽

Ultrasound Scan ◽

Service Model ◽

Abortion Care ◽

Before And After ◽

Future Preference

AbstractObjectivesTo compare the effectiveness, safety and acceptability of medical abortion before and after the introduction of no-test telemedicine abortion care.DesignCohort study to assess whether a no-test telemedicine-hybrid care model (telemedicine with in-person provision only when indicated) was non-inferior to the traditional service model (blanket in-person provision including ultrasound scan).SettingThe three main abortion providers in England and Wales.ParticipantsAll patients having an early medical abortion in the two months before and after the service model change. Patient demographic and clinical characteristics were compared between the cohorts to adjust for any systematic differences in the two groups.Main outcome measuresAccesswaiting time, gestation at abortionEffectivenessthe proportion of successful medical abortionsSafetysignificant adverse events defined as: haemorrhage requiring transfusion, significant infection requiring hospital admission, major surgery, death. We also examined the incidence of ectopic pregnancy and late gestation.AcceptabilityPatient-reported outcomes of satisfaction, future preference, and privacy of consultationResultsThe study sample included 52,142 medical abortions; 22,158 in the traditional cohort and 29,984 in the telemedicine-hybrid cohort, of which 61% were provided using no-test telemedicine. The cohorts accounted for 85% of all medical abortions provided in England and Wales during the study period. Mean waiting times were 4.2 days shorter in the telemedicine-hybrid cohort, and 40% were provided at ≤6 weeks’ gestation compared to 25% in the traditional cohort (p<0.001). There was no difference in success rates between the two groups (98.2% vs. 98.8%, p=1.0), nor in the prevalence of serious adverse events (0.04% vs. 0.02%, p=0.557). The incidence of ectopic pregnancy was equivalent in both cohorts (0.2%, p=0.796), with no significant difference in the proportions being treated after abortion (0.01% vs 0.03%, p=0.123). In 0.04% of cases the abortion appeared to have been provided at over 10 weeks’ gestation; these abortions were all completed at home without additional medical complications. In the telemedicine-hybrid group, the effectiveness for abortions conducted using telemedicine (n=18,435) was higher than for those conducted in-person (n=11,549), 99.2% vs. 98.1%, p<0.001. Acceptability was high (96% satisfied), 80% reported a future preference for telemedicine and none reported that they were unable to consult in private using teleconsultation.ConclusionsMedical abortion provided through a hybrid model that includes no-test telemedicine without routine ultrasound is effective, safe, acceptable, and improves access to care.Summary BoxWhat is already known on this topicThe UK’s National Institute for Health and Care Excellence (NICE) conducted a systematic review and recommended using telemedicine to improve access to medical abortion care.Several models for using telemedicine to facilitate medical abortion have been described, but most existing trials are small, and many required attendances to have medicines administered or for an ultrasound scan or blood tests.What this study addsThis study (n=52,142) is the first to assess a real-world no-test telemedicine abortion care pathway in a national population. The new national model demonstrates how a permissive framework for medical abortion can deliver significant quality improvements to those needing to access abortion care. There was no difference in effectiveness (p=1.0) or safety (p=0.6) when compared to a traditional in-person model, but the no-test telemedicine pathway improved access to care, was highly acceptable to patients and is likely to be especially beneficial for vulnerable groups and in resource-poor settings.

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Effectiveness, Safety, and Acceptability of Medical Abortion at Home vs. In the Clinic: A Systematic Review and Meta-Analysis in Response to COVID-19

SSRN Electronic Journal ◽

10.2139/ssrn.3679864 ◽

2020 ◽

Author(s):

Katherine Gambir ◽

Camille Garnsey ◽

Kelly Ann Necastro ◽

Thoai D. Ngo

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Medical Abortion ◽

At Home

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Introducing a trial without catheter at home service; improving care in postnatal women

International Journal of Urological Nursing ◽

10.1111/ijun.12188 ◽

2019 ◽

Vol 13 (2) ◽

pp. 88-88

Author(s):

Tracy Ord ◽

Kayleigh Brownlee-Moore ◽

Shirley Mason

Keyword(s):

Home Service ◽

Postnatal Women ◽

Trial Without Catheter ◽

At Home

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Tetracyclines in COVID ‐19 patients quarantined at home: Literature evidence supporting real‐world data from a multicenter observational study targeting inflammatory and infectious dermatoses

Dermatologic Therapy ◽

10.1111/dth.14694 ◽

2020 ◽

Author(s):

Laura Cristina Gironi ◽

Giovanni Damiani ◽

Elisa Zavattaro ◽

Alessia Pacifico ◽

Pierachille Santus ◽

...

Keyword(s):

Observational Study ◽

Real World ◽

Real World Data ◽

World Data ◽

Multicenter Observational Study ◽

Literature Evidence ◽

At Home

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Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200954 ◽

2021 ◽

pp. bmjsrh-2020-200954

Author(s):

Chelsey Porter Erlank ◽

Jonathan Lord ◽

Kathryn Church

Keyword(s):

Patient Reported Outcomes ◽

Medical Abortion ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Post Procedure ◽

High Satisfaction ◽

First Choice ◽

Patient Reported ◽

At Home

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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The level of unpleasantness of pain influences the choice of home treatment during medical abortion

Scandinavian Journal of Pain ◽

10.1016/j.sjpain.2010.09.007 ◽

2011 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Satu Suhonen ◽

Marja Tikka ◽

Seppo Kivinen ◽

Timo Kauppila

Keyword(s):

Medical Abortion ◽

Nulliparous Women ◽

Home Based ◽

Vaginal Deliveries ◽

Multiparous Women ◽

Induced Abortions ◽

Pain Drawings ◽

Nonopioid Analgesics ◽

Post Abortion ◽

At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

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