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 Although surgical abortions require clinic visits, roughly one
quarter of abortions are done with medication and might be provided
with telemedicine – using webcams and video chats to diagnose and
treat these patients, Dr. Elizabeth Raymond of Gynuity Health
Projects in New York and colleagues argue in JAMA Internal Medicine.
“The use of telemedicine is growing,” Raymond said by email. “It has
tremendous potential to make many essential services more
accessible, more convenient and cheaper. Medical abortion is such a
service.”
For many U.S. women, obtaining an abortion is difficult because they
live at least 100 miles away from the nearest clinic, the authors
note. Mississippi, Missouri, South Dakota and North Dakota each only
have one abortion clinic, and Wyoming has none.
Medical abortions performed before 10 weeks of gestation with two
drugs – mifepristone and misoprostol – can be self-administered at
home. Healthcare providers can use telemedicine to interview
patients and assess potential safety issues by reviewing lab test
results and ultrasounds before prescribing medication, the authors
note.
In the two-step medical abortion regimen typically used in the U.S.,
women first take mifepristone. This pill works by blocking the
hormone progesterone, which causes the lining of the uterus to break
down and makes it impossible for the pregnancy to continue. Then, 24
to 48 hours later, women take misoprostol, which causes the uterus
to empty.
Women are usually advised to have a clinic visit within two weeks to
confirm the pregnancy was terminated. In rare cases when ultrasound
or a blood test shows the medical abortion didn’t succeed, women
require surgical abortions.
In 2008, a Planned Parenthood affiliate in Iowa initiated the first
formal telemedicine abortion program in the U.S. with physicians
reviewing labs and imaging then speaking to patients to determine if
the clinic should be authorized to dispense medical abortion pills.
In the first year, this program nearly tripled the number of sites
in Iowa offering abortion services, from six to 17, the researchers
report.
Among 233 women with follow-up, the treatment was successful 99
percent of the time. One patient had a blood transfusion in an
emergency department, and there were no other serious adverse events
reported.
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Direct-to-patient telemedicine programs for medical abortions are
available in the Canadian province of British Columbia and in
Australia, the authors note.
But in the U.S., regulators require that abortion medications be
dispensed to patients in clinics, medical offices and hospitals.
Widespread use of telemedicine for medical abortions in the U.S. is
also restricted because some states require in-person exams or have
banned telemedicine abortions, the authors note.
“Currently, more than half of rural women don’t have access to
reproductive health services anywhere in their county,” said Katy
Kozhimannil, a researcher in health policy at the University of
Minnesota School of Public Health in Minneapolis who wasn’t involved
in the study.
“For these women, telemedicine can make medication abortions more
accessible,” Kozhimannil added by email.
“Non-clinical factors, including state and federal regulations,
influence requirements such as exams and in-person clinician
visits,” Kozhimannil said. “Many of these decisions are influenced
by political factors, and not explicitly made based on medical
evidence.”
SOURCE: http://bit.ly/22Iat5T JAMA Internal Medicine, online March
28, 2016.
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