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Effectiveness, safety and acceptability of no-test medical abortion provided via telemedicine: a national cohort study
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  • Abigail Aiken,
  • Patricia Lohr,
  • Jonathan Lord,
  • Nabanita Ghosh,
  • Jennifer Starling
Abigail Aiken
University of Texas at Austin
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Patricia Lohr
British Pregnancy Advisory Service
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Jonathan Lord
MSI Reproductive Choices
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Nabanita Ghosh
National Unplanned Pregnancy Advisory Service
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Jennifer Starling
Mathematica Policy Research inc Cambridge Office
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Objective To compare the effectiveness, safety and acceptability of medical abortion before and after the introduction of no-test telemedicine Design Cohort study Setting The three main abortion providers in England Population All patients having an early medical abortion (comprising 85% of all medical abortions performed nationally) Methods Comparison of no-test telemedicine hybrid model vs. traditional model (blanket in-person provision including ultrasound), adjusted for baseline differences Main outcome measures Access: waiting time, gestation Effectiveness: successful medical abortion Safety: significant adverse events; ectopic pregnancy and late gestation Acceptability: Patient-reported outcomes Results 52,142 medical abortions were conducted, 29,984 in the telemedicine-hybrid cohort and 22,158 in the traditional cohort. Mean waiting times were 4.2 days shorter in the telemedicine-hybrid cohort and 40% were ≤6 weeks’ gestation vs. 25% in the traditional cohort (p<0.001). There was no difference in success rates (98.8% vs. 98.2%, p=1.0), nor in prevalence of serious adverse events (0.02% vs. 0.04%, p=0.557). Incidence of ectopic pregnancy was equivalent in both cohorts (0.2%, p=0.796); 0.04% of abortions appeared to have been provided after 10 weeks’ gestation with all completed safely at home. In the telemedicine-hybrid cohort, effectiveness was higher in the telemedicine group vs. the in-person group (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. Conclusions Medical abortion provided through a hybrid model that includes no-test telemedicine without ultrasound is effective, safe, acceptable, and improves access to care. Funding None

Peer review status:ACCEPTED

07 Dec 2020Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
08 Dec 2020Submission Checks Completed
08 Dec 2020Assigned to Editor
11 Dec 2020Reviewer(s) Assigned
16 Dec 2020Review(s) Completed, Editorial Evaluation Pending
29 Dec 2020Editorial Decision: Revise Major
05 Jan 20211st Revision Received
09 Jan 2021Submission Checks Completed
09 Jan 2021Assigned to Editor
09 Feb 2021Editorial Decision: Accept