A recent study conducted in Washington State has shown that virtual medication abortions led to high patient satisfaction, with telemedicine services often surpassing traditional in-clinic consultations. The study, published in Obstetrics & Gynecology, underscored the value of patient-centered communication skills in reproductive health services, regardless of the mode of delivery.
Two decades ago, the US Food and Drug Administration (FDA) marked a significant advancement in abortion care by approving mifepristone for use in combination with misoprostol – a regimen now known as the “abortion pill” or medication abortion. Today, this method has emerged as the dominant choice for abortion in the United States, a shift underpinned by the Guttmacher Institute’s latest research.
The Institute’s comprehensive census of all known abortion providers in 2020 revealed that medication abortion had, for the first time, accounted for the majority of all abortions in the US. This accounted for 53% of all abortions, a striking increase from the 39% recorded in 2017. Furthermore, preliminary data for 2021, released in February 2022, suggested that this trend continued, with medication abortions representing 54% of all US abortions.These figures not only emphasize the wide acceptance and use of medication abortion among patients and providers, but also underscore its safe and effective use over the past two decades. Indeed, this evidence solidifies the integral role medication abortion plays in the provision of US abortion services.
Against this backdrop of the increasing popularity of medication abortion, the Washington State study further explored patients’ personal experiences, taking into account both telemedicine and traditional in-clinic services. The researchers used semi-structured interviews with 30 participants aged between 20 and 38 years, who had undergone medication abortion through either live telemedicine or in-clinic services. The participants’ feedback illuminated their experiences with the abortion consultation, including the healthcare provider’s communication approach, the relay of pertinent medical information, and the overall setting.
Participants who opted for telemedicine services reported experiencing high-quality communication with their clinicians, greatly benefiting from the ability to choose their consultation locations. These patients described feeling significantly more relaxed during their appointments compared to their counterparts who used traditional in-clinic services. In contrast, in-clinic patients often found their appointments lengthy, chaotic, and lacking comfort. Despite these challenges, however, overall satisfaction levels remained high for both groups. Importantly, both groups emphasized the value of clear medical information about the abortion pills usage and leaned heavily on a mix of clinic-provided materials and online resources for additional support during the at-home termination process.
Dr. Emily Godfrey, lead author of the study and a UW Medicine OB-GYN and family medicine doctor, explained the importance of the patients’ positive perception of their care. “Telehealth patients felt very positive about the care they received, in part due to not having to struggle with transportation,” she said. “They could have the appointment in their car, during their lunch hour, or in a private space at a friend’s home.”
In Washington State, medication abortions represent nearly 60% of all abortions, exceeding the national average. Notably, the adoption of telemedicine services for these procedures saw a sharp increase in response to the FDA’s relaxation of in-person requirements in 2019 amid the COVID-19 pandemic. Following the overturning of Roe vs. Wade in the Dobbs decision last June, the utilization of telemedicine for medication abortions rose even further, experiencing a surge of 137% as reported by the Society of Family Planning WeCount study.
The implications of these findings become particularly crucial as the 5th U.S. Circuit Court of Appeals prepares to consider reinstating in-person clinic requirements for obtaining abortion pills. “Such a move would be harmful for patients, given previous evidence about travel to clinics being a barrier to medical access and the demonstrated success of patient-centered care via telemedicine,” said Dr. Godfrey.
This study’s findings underscore the potential of telemedicine as a tool to provide quality, patient-centered reproductive health services, contributing to broader healthcare improvement goals, particularly for rural populations or those who may have difficulty accessing medical clinics.