BRIEF REPORT
Silpa Srinivasulu, PhD, MPH; Deyang Nyandak, MD; Anna E Fiastro, PhD, MPH, MEM; Honor MacNaughton, MD; Amy Tressan, MD; Emily M. Godfrey, MD, MPH
Corresponding Author: Silpa Srinivasulu, PhD, MPH; Reproductive Health Access Project
Email: silpa@reproductiveaccess.org
DOI: 10.3122/jabfm.2023.230178R1
Keywords: Abortion-Induced, Access to Health Care, Logistic Regression, Mifepristone, Patient-Centered Care, Primary Health Care, Quantitative Research, Reproductive Health, Retrospective Studies, Telehealth, Women's Health
Dates: Submitted: 05-05-2023; Revised: 08-21-2023; Accepted: 11-13-2023
FINAL PUBLICATION: |HTML| |PDF|
INTRODUCTION: Providing abortion in primary care expands access and alleviates delays. The 2020 COVID-19 public health emergency (PHE) led to the expansion of telehealth, including medication abortion (MAB). This study evaluated the accessibility of novel telehealth MAB (teleMAB) initiated during the PHE, with the lifting of mifepristone restrictions, compared to traditional in-clinic MAB offered before the PHE at a Massachusetts safety-net primary care organization.
METHODS: We conducted a retrospective electronic medical record review of 267 MABs. We describe sociodemographic, care access, and complete abortion characteristics and compare differences between teleMAB and in-clinic MABs using chi-square, fisher’s exact test, independent t-test, and Wilcoxon rank sum. We conducted logistic regression to examine differences in time to care (6 days or less vs. 7 days or more).
RESULTS: 184 MABs were eligible for analysis (137 in-clinic, 47 teleMAB). Patients were not significantly more likely to receive teleMAB versus in-clinic MAB based on race, ethnicity, language, or payment. Completed abortion did not significantly differ between groups (p=0.187). Patients received care more quickly when accessing teleMAB compared to usual in-clinic MAB (median 3 days range 0-20 vs. median 6 days range 0-32; p <.001). TeleMAB patients had 2.29 times the odds of having their abortion appointment within 6 days compared to in-clinic (95% CI: 1.13, 4.86).
CONCLUSION: TeleMAB in primary care is as effective, more timely, and potentially more accessible than in-clinic MAB when in-person mifepristone regulations were enforced. TeleMAB is feasible and can promote patientcentered and timely access to abortion care.