Perceived Importance of Abortion Care Features and Access to Telehealth Technologies Among Medication Abortion Patients by Abortion Care Model: Cross-Sectional Analysis of a Prospective Cohort Study.

Abstract

Medication abortion accounts for the majority of abortions in the United States, driven in part by the growth in access to telehealth provision of medication abortion. While research indicates high patient satisfaction with telehealth medication abortion care, research on care preferences of patients who use medication abortion remains understudied. Understanding these preferences is essential to informing evidence-based policies that enable people to access person-centered abortion services that meet their values, preferences, and needs. The aim of this study is to compare the abortion care features rated as most important among patients receiving medication abortion via telehealth vs in-person care and to assess participants' access to technologies required for telehealth care. We hypothesized that participants receiving telehealth care would place greater importance on features supporting limited in-person clinic interaction. From May 2021 to March 2023, we surveyed participants (≤70 d of gestation, English or Spanish speakers, aged ≥15 y) obtaining medication abortion at 4 organizations providing care in 6 US states. Participants rated the importance of 12 abortion care features (ie, getting care at home, convenience, cost, safety, effectiveness, and privacy) and described access to technologies required for telehealth. We used bivariable logistic and ordinal regressions with robust SEs to assess whether features rated as "extremely important" differed by the medication abortion model received (telehealth vs in-person). Among 1017 patients approached, 876 were eligible, 583 participants enrolled, 487 initiated a survey, 477 (242 telehealth and 235 in-person) completed survey questions regarding access to technologies for telehealth, and 397 completed questions about abortion care features. Across groups, the features most often rated as "extremely important" included effectiveness (340/397, 85.6%), safety (326/397, 82.1%), timeliness (307/397, 77.3%), and privacy (165/211, 78.2%), with no significant differences (P>.05) between groups. Compared to in-person participants, telehealth participants were more likely to report getting care at home (65.9% vs 43.5%; odds ratio [OR] 2.48, 95% CI 1.57-3.89; P<.001) and having a medication abortion (62.1% vs 51.1%; OR 1.58, 95% CI 1.11-2.23; P=.01) as extremely important. They were less likely to report having an in-person meeting with a clinician (16.1% vs 45.7%; OR 0.23, 95% CI 0.19-0.26; P<.001) and ultrasonography (15.2% vs 38.2%; OR 0.28, 95% CI 0.20-0.40; P<.001) as extremely important. Abortion care features rated as extremely important were sometimes discordant with the care received. Almost all participants had access to the technologies required for telehealth. While telehealth abortion services offer many features that people find important, the availability of both telehealth and in-person abortion care remains critical to ensuring that care aligns with patient preferences. In addition to efforts focused on expanding access to telehealth medication abortion services, advocates and policymakers should continue their work to ensure access to in-person care for those who need or prefer this model.