Complete abortion rates are similar between medication abortion following no-test telehealth screening and in-person care with ultrasonography, according to a recent study published in JAMA Network Open.1
Takeaways
- Medication abortions conducted via telehealth with mailed medications are as effective as those done with in-person care, achieving complete abortion rates of 95% or higher.
- Serious adverse events are rare in both telehealth and in-person abortion methods, with rates under 1.5%, demonstrating the safety of telehealth services.
- The rate of medication abortions has increased significantly, from 31% in 2014 to 63% in 2023, indicating growing acceptance and use of this method.
- The study supports the viability of telehealth for medication abortion, especially with the no-test telehealth model involving mailed medications, which showed noninferiority compared to in-person care.
- The findings may inform policies and counteract efforts to restrict access to telehealth medication abortions, reinforcing the approach as a safe and effective option.
The FDA first approved a mifepristone and misoprostol regimen for medication abortion in 2000, with use currently approved through 70 days’ gestation. Rates of medication abortion have increased over time, at 63% in 2023 vs 53% in 2020 and 31% in 2014.
Additionally, the safety and efficacy of this regimen has been well-established, with a serious adverse event (SAE) rate under 0.5% and overall efficacy of 95% to 97%. Access to medication abortion models has also expanded, including mailing medications directly to patients and removing the need for in-person ultrasonography.1
Data has indicated an increase in the demand for abortion services nationwide.2 In 2020, the rate of overall abortion was increased by 8% vs 2017, and the rate of medication abortion was increased by 45%. Clinic protocols were also adjusted during this period to include pre- and post-abortion counseling in response to COVID-19.
Evidence about the efficacy of these telehealth and in-person, no-test models is necessary.1 To evaluate their safety and efficacy, investigators conducted an observational, prospective cohort study. Methods of eligibility assessment and dispensing of medications were compared in the analysis.
Abortion-providing organizations in Colorado, Illinois, Maryland, Virginia, and Washington participated in the trial. Participants included patients aged at least 15 years or at least 19 years intending to receive medication abortion at up to 70 days’ gestation.
Data was obtained from electronic surveys completed by participants 1 day, 2 weeks, and 1 month after receiving medication. Additionally, a standardized tool was used to abstract medical record data from clinics 6 weeks following the initial appointment.1
The model of abortion care was the primary exposure and included a telehealth eligibility assessment and mailing of medications, no-test eligibility assessment remotely or in-person with pickup of medications, and in-personal ultrasonography assessment and pickup. These models were referred to as no-test + mail, no-test + pickup, and in-person, respectively.
The effectiveness of medication abortion was the primary outcome, determined by a complete abortion with no additional treatment needed. This outcome was assessed using self-reported survey data and clinic chart-abstracted data.1
Safety was reported as a secondary outcome, determined by any abortion-related SAE. Cofounders included race and ethnicity, age, parity, gestational duration, and prior abortion.
There were 537 patients included in the final analysis, aged a median 26 years. Of patients, 48.6% were non-Hispanic White, 28.1% non-Hispanic Black, 12.1% other races, and 9.6% Hispanic. A prior abortion was reported in 42.6%, and the median gestation duration at screening was 45 days.1
A complete abortion without additional treatment was reported in 95% of participants. The in-person group had an unadjusted efficacy of 94.1%, vs 95.1% in the no test + mail group and 96.5% in the no test + pickup group.
An adjusted risk difference of 1.2% was reported for the in-person and no-test + mail groups. This was above the limit of -5%, indicating noninferiority from telehealth and mailed medications care.1
Adjusted efficacy rates were 93.3% from in-person care and 94.4% for no-test + mail care. Similar results were reported when comparing the in-person and no-test + pickup groups.
An SAE was reported in 1.1% of participants and included 4 overnight hospitalizations, 2 blood transfusions, and 1 surgery. Unadjusted SAE rates were 1.5% for the telehealth+ mail group and 1.4% for the in-person group, and none were reported in the no test + pickup group. This indicated noninferiority from the no-test + mail model.
These results indicated similar rates of abortion completion and low adverse events from no-test telehealth + mailing of medication methods vs in-person care. Investigators concluded these results may be used to refute efforts to regulate and restrict access to medication abortion.1
References
- Ralph LJ, Baba CF, Biggs MA, McNicholas C, Hagstrom Miller A, Grossman D. Comparison of no-test telehealth and in-person medication abortion. JAMA. 2024. doi:10.1001/jama.2024.10680
- Jones RK, Kirstein M, Philbin J. Abortion incidence and service availability in the United States, 2020. Perspective on Sexual and Reproductive Health. 2022. doi:10.1363/psrh.12215
