Similar safety, success with mail-order telehealth, in-person abortion medication care

Key takeaways:

• Complete abortion rates were similar for no-test telehealth with mailed medications or medication pickup and in-person care.
• All groups had low rates of serious adverse events.

Obtaining medication abortion after no-test telehealth screening and mail-order medication dispensing was tied to similar abortion completion rates as in-person care with ultrasonography, according to study results published in JAMA.

“In recent years, access to various medication abortion models has expanded rapidly, including telehealth or virtual eligibility assessment and counseling, mailing medications directly to patients and, in some instances, forgoing the requirement for an in-person ultrasonography or physical examination to establish location and duration of pregnancy prior to provision of medication abortion,” Lauren J. Ralph, PhD, MPH, associate professor for Advancing New Standards in Reproductive Health at the University of California, San Francisco, and colleagues wrote. “The FDA’s removal of the in-person dispensing requirement for mifepristone, which had long been part of the drug’s Risk Evaluation and Mitigation Strategy, facilitated this expansion. Emerging research evaluating the safety and effectiveness of telehealth and in-person, no-test models builds on prior evidence demonstrating that provision of medication abortion by telemedicine ... has a comparable safety and effectiveness profile to in-person provision.”

Ralph and colleagues conducted a prospective, observational study with noninferiority analysis with 585 English- or Spanish-speaking women and girls (mean age, 27.3 years; 48.6% white) aged 15 years or older at 70 days’ gestation seeking medication abortion. Researchers evaluated whether medication abortion with no-test eligibility assessment and mail-order medication dispensing was as effective and safe as in-person care at abortion-providing organizations in Colorado, Illinois, Maryland, Minnesota, Virginia and Washington from May 2021 to March 2023.

All patients were grouped by model of care: no-test eligibility assessment with mailed medications (n = 228), no-test eligibility assessment with medication pickup (n = 119) or in-person care with ultrasonography (n = 238).

Primary outcomes were model effectiveness defined as complete abortion without requiring repeated mifepristone and misoprostol regimen or follow-up procedures and safety defined as an abortion-related serious adverse event.

Overall, median gestation duration was 45 days in all groups. Most participants (91.8%) had outcome data available for analysis.

In adjusted models, effectiveness was 94.4% for no-test with mailed medications, 95% for no-test with medication pickup and 93.3% for in-person care, indicating noninferiority of no-test telehealth screening and mail-order medications.

Researchers observed a serious adverse event for three patients in the no-test with mailed medications group and three patients in the in-person care group with four requiring overnight hospitalization, two requiring blood transfusion and one requiring surgery.

“Expansion of telehealth and no-test or history-based models offers a safe and effective, as well as urgently needed, way to overcome at least some of the logistical and geographic barriers to accessing abortion,” the researchers wrote.