Advanced practice clinicians and medication abortion safety: A 10-year Retrospective Review

Abstract

Introduction Expanding the pool of trained, competent medication abortion providers is critical to filling gaps in access to safe abortion across the U.S. Despite a compelling public health argument for advanced practice clinicians (APCs) as abortion providers and the recent label change to mifepristone, 34 states currently mandate that clinicians providing medication abortion must be physicians. Method We performed a retrospective observational cohort study of medication abortion and clinician personnel data from the electronic medical record (EMR), quality management incident tracking, and human resources records at a large, urban-based sexual and reproductive health care provider between January 2009 and December 2018 to describe medication abortion outcomes when provided by APCs. We calculated descriptive statistics to assess overall abortion outcomes and complications. In order to assess complications by provider years of experience, we ran a negative binomial regression on total complications, using an offset term of the natural log of the total number of procedures with follow up to estimate a rate ratio. Results A total of 59,189 patients initiated medication abortion during the observation period under the supervision of 47 APCs. Among the 37,909 (64%) patients who completed follow up, outcomes included: 98.4% complete abortion, 1.1% failed abortion, 0.4% incomplete abortion, and 0.1% ectopic pregnancy. There were no meaningful differences in characteristics among patients who completed or failed to complete follow-up. 246 (0.6%) patients experienced complications requiring in-clinic management, ED referral, or hospital admission. .Most common interventions included aspiration (n = 112), blood transfusion (n = 36), and/or IV fluids (n = 34). We found no association between provider years of experience and complication rates (RR = 1.00, 95% CI 0.97, 1.04), restricting analyses to providers for whom there was follow-up data on at least 60% of cases in a given year. Conclusions Outcomes of medication abortion provided by APCs in our study are well within published benchmarks for medication abortion effectiveness (95–99%) and safety (