Effectiveness, safety and acceptability of no-test medical abortion provided via telemedicine: a national cohort study.

OBJECTIVE: To compare outcomes before and after implementation of medical abortion without ultrasound via telemedicine DESIGN: Cohort analysis SETTING: The three main abortion providers in England POPULATION OR SAMPLE: Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n=22,158) from January-March 2020 vs. telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n=29,984 of whom 18,435 had no-test telemedicine) between April-June 2020. Sample (n=52,142) comprises 85% of all medical abortions provided nationally. METHODS: Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. MAIN OUTCOME MEASURES: Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability RESULTS: Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% vs. 25%, p 0.999), serious adverse events (0.02% vs. 0.04%, p=0.557), and incidence of ectopic pregnancy (0.2% vs. 0.2%, p=0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% vs. 98.1%, p<0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. CONCLUSIONS: A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable, and improves access to care.