Comparing Efficacy of Medication Abortion by Health Care Modality at a California Health System.

Abstract

To compare the efficacy and safety of telemedicine medication abortion and clinic-based medication abortion among patients at one academic health system in California. We conducted a retrospective cohort study of electronic medical records for all patients who had either telemedicine medication abortion or clinic-based medication abortion up to 77 days of gestation between April 1, 2020, and December 31, 2022. All patients who met eligibility requirements were offered telemedicine medication abortion. Patients who were not eligible for or did not prefer telemedicine medication abortion completed clinic-based medication abortion. We examined attendance at follow-up visits, successful medication abortion without requiring surgical intervention, and occurrence of serious adverse events. Among patients who had telemedicine medication abortion, we also examined attendance at 4-week follow-up visits and results of home urine pregnancy tests. Overall, 165 patients who had telemedicine medication abortion and 411 patients who had clinic-based medication abortion were included in the study. A total of 91.6% of patients who had telemedicine medication abortion and 84.5% of patients who had clinic-based medication abortion completed at least one follow-up visit, with no significant difference detected by modality after controlling for covariates (adjusted odds ratio [aOR] 1.90, 95% CI, 0.96-3.77). Ninety percent of patients who had telemedicine medication abortion and 88.4% of patients who had clinic-based medication abortion had successful abortions without requiring surgical intervention. Odds of successful abortions did not statistically significantly differ by medication abortion modality (aOR 0.78, 95% CI, 0.38-1.59). Because of the rarity of serious adverse events (less than 1% in both groups, all requiring either intravenous antibiotics or blood transfusions), we could not complete multivariable models for this outcome. Our findings from one academic health system in California support prior studies showing that telemedicine medication abortion and clinic-based medication abortion are equally effective. When possible, the provision of telemedicine medication abortion should be expanded to meet the growing demand for abortion access.