Abstract
ObjectiveEvaluate satisfaction and experience with telemedicine consultation and home use of mifepristone and misoprostol for abortion to 10 weeks’ gestation. Study DesignCross-sectional evaluation of British Pregnancy Advisory Service (BPAS) clients who used mifepristone and misoprostol at home from 11 May to 10 July 2020. We sent a text message with a link to a web-survey 2 to 3 weeks postabortion. Questions assessed satisfaction and experiences with a service model including telephone consultation and provision of medicines by mail or collection from the clinic. We used bivariate and multivariate regression to explore associations between client characteristics and outcomes. Our primary outcomes were overall satisfaction (5-point Likert scale) and reported contact with a health care provider. ResultsA total of 1,333 clients participated. Respondents described home use of medications as “straightforward” (75.8%) and most were “very satisfied” (78.3%) or “satisfied” (18.6%) overall. Being “very satisfied” was associated with parity (aOR 1.53, 95% CI 1.09−2.14) and pain control satisfaction (aOR 2.22, 95% CI 1.44−3.44). Health care provider contact was reported by 14.7%; mainly to BPAS’ telephone aftercare service (76.8%). Dissatisfaction with pain control (aOR 3.62, 95% CI 1.79−7.29) and waiting >1 week to use mifepristone (aOR3.71, 95% CI 1.48−9.28) were associated with health care provider contact. If needed in the future, most would prefer consultation by phone (74.3%) and home use of mifepristone and misoprostol (77.8%). ConclusionsSatisfaction with telemedicine and home use of mifepristone and misoprostol is high. Most clients do not need health care provider support when administering medicines at home or post abortion.
Highlights
Despite evidence that home use of mifepristone and misoprostol for medication abortion is safe and effective, restrictions remain common [1,2]
After adjusting for confounders, we identified an association between being “very satisfied” and being parous or being satisfied with pain control
After adjusting for confounders, we found an association between contact with a health care provider and dissatisfaction with pain control or waiting more than a week between receipt and use of medicines
Summary
Despite evidence that home use of mifepristone and misoprostol for medication abortion is safe and effective, restrictions remain common [1,2]. In 2018, England, Wales, and Scotland approved a person’s home for use of misoprostol [4], but mifepristone administration remained restricted to a clinic or hospital. Tional guidance released during the pandemic recommended telemedicine models to preserve access to abortion care while protecting health care staff and clients from potential COVID exposure [5]. The English and the Welsh governments issued temporary approvals for home use of mifepristone and misoprostol up to 10 weeks’ gestation [6]. Updated national guidance endorsed a fully telemedicine model for medication abortion care including telephone assessment, gestational age determination by last menstrual period (LMP) with ultrasound only when necessary, and direct-toclient provision of medicines
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