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      Women’s experiences of a telemedicine abortion service (up to 12 weeks) implemented during the coronavirus (COVID‐19) pandemic: a qualitative evaluation

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          Abstract

          Objective

          To explore the experiences of women in Scotland who accessed medical abortion at home up to 12 weeks’ gestation, delivered via a telemedicine abortion service implemented in response to the coronavirus (COVID‐19) pandemic, to identify areas for improvement and inform service provision.

          Design

          Qualitative interview study.

          Setting

          Abortion service in one National Health Service health board in Scotland.

          Population or sample

          Twenty women who accessed telemedicine abortion services and self‐administered mifepristone and misoprostol at home up to 12 weeks’ gestation.

          Methods

          Thematic analysis of semi‐structured qualitative interviews, informed by the Framework analytic approach.

          Main outcome measures

          Women’s experiences of accessing telemedicine for medical abortion at home, specifically: acceptability of the telephone consultation and remote support; views on no pre‐abortion ultrasound scan; and self‐administration of abortion medications at home.

          Results

          Novel study findings were three‐fold: (1) participants valued the option of accessing abortion care via telemedicine and emphasised the benefits of providing a choice of telephone and in‐person consultation to suit those with different life circumstances; (2) the quality of abortion care was enhanced by the telemedicine service in relation to access, comfort and flexibility, and ongoing telephone support; (3) participants described being comfortable with, and in some cases a preference for, not having an ultrasound scan.

          Conclusions

          This research demonstrates support for the continuation of telemedicine abortion services beyond the temporary arrangements in place during COVID‐19, and lends weight to the argument that offering the option of telemedicine abortion care can enable women to access this essential health service.

          Tweetable abstract

          #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.

          Tweetable abstract

          #Telemedicine provision of medical #abortion at home up to 12 weeks’ gestation is acceptable and highly valued by #women #Research #SRHR @nbw80 @doctorjjrw @jeniharden @cameronsharon @mrc_crh @edinuniusher.

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          Most cited references35

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          Using the framework method for the analysis of qualitative data in multi-disciplinary health research

          Background The Framework Method is becoming an increasingly popular approach to the management and analysis of qualitative data in health research. However, there is confusion about its potential application and limitations. Discussion The article discusses when it is appropriate to adopt the Framework Method and explains the procedure for using it in multi-disciplinary health research teams, or those that involve clinicians, patients and lay people. The stages of the method are illustrated using examples from a published study. Summary Used effectively, with the leadership of an experienced qualitative researcher, the Framework Method is a systematic and flexible approach to analysing qualitative data and is appropriate for use in research teams even where not all members have previous experience of conducting qualitative research.
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            Telemedicine for medical abortion: a systematic review

            Background Telemedicine is increasingly being used to access abortion services. Objective To assess the success rate, safety, and acceptability for women and providers of medical abortion using telemedicine. Search strategy We searched PubMed, EMBASE, ClinicalTrials.gov, and Web of Science up until 10 November 2017. Study criteria We selected studies where telemedicine was used for comprehensive medical abortion services, i.e. assessment/counselling, treatment, and follow up, reporting on success rate (continuing pregnancy, complete abortion, and surgical evacuation), safety (rate of blood transfusion and hospitalisation) or acceptability (satisfaction, dissatisfaction, and recommendation of the service). Data collection and analysis Quantitative outcomes were summarised as a range of median rates. Qualitative data were summarised in a narrative synthesis. Main results Rates relevant to success rate, safety, and acceptability outcomes for women ≤10+0 weeks’ gestation (GW) ranged from 0 to 1.9% for continuing pregnancy, 93.8 to 96.4% for complete abortion, 0.9 to 19.3% for surgical evacuation, 0 to 0.7% for blood transfusion, 0.07 to 2.8% for hospitalisation, 64 to 100% for satisfaction, 0.2 to 2.3% for dissatisfaction, and 90 to 98% for recommendation of the service. Rates in studies also including women >10+0 GW ranged from 1.3 to 2.3% for continuing pregnancy, 8.5 to 20.9% for surgical evacuation, and 90 to 100% for satisfaction. Qualitative studies on acceptability showed no negative impacts for women or providers. Conclusion Based on a synthesis of mainly self‐reported data, medical abortion through telemedicine seems to be highly acceptable to women and providers, success rate and safety outcomes are similar to those reported in literature for in‐person abortion care, and surgical evacuation rates are higher. Tweetable abstract A systematic review of medical abortion through telemedicine shows outcome rates similar to in‐person care.
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              Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

              Objective To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine. Design Cohort analysis. Setting The three main abortion providers. 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 to March 2020 versus telemedicine‐hybrid model (either in person or via telemedicine without ultrasound, n  = 29 984, of whom 18 435 had no‐test telemedicine) between April and 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% versus 25%, P  < 0.001). Treatment success (98.8% versus 98.2%, P  > 0.999), serious adverse events (0.02% versus 0.04%, P  = 0.557) and incidence of ectopic pregnancy (0.2% versus 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% versus 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. Tweetable abstract Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care. Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care. This article includes Author Insights, a video abstract available at https://vimeo.com/bjog/authorinsights16668
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                Author and article information

                Contributors
                Nicola.Boydell@ed.ac.uk
                Journal
                BJOG
                BJOG
                10.1111/(ISSN)1471-0528
                BJO
                Bjog
                John Wiley and Sons Inc. (Hoboken )
                1470-0328
                1471-0528
                27 July 2021
                27 July 2021
                : 10.1111/1471-0528.16813
                Affiliations
                [ 1 ] Usher Institute University of Edinburgh Edinburgh UK
                [ 2 ] NHS Lothian Edinburgh UK
                [ 3 ] MRC Centre for Reproductive Healthcare University of Edinburgh Edinburgh UK
                Author notes
                [*] [* ] Correspondence: Dr N Boydell, Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, 23 Buccleuch Place, Edinburgh EH8 9LN, UK. Email: Nicola.Boydell@ 123456ed.ac.uk

                Author information
                https://orcid.org/0000-0002-2260-8020
                https://orcid.org/0000-0001-6597-1666
                https://orcid.org/0000-0002-1168-2276
                https://orcid.org/0000-0002-6011-6254
                Article
                BJO16813
                10.1111/1471-0528.16813
                8441904
                34138505
                2a9d9d00-323d-4137-a758-549bec2750bd
                © 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 March 2021
                Page count
                Figures: 0, Tables: 4, Pages: 10, Words: 13026
                Funding
                Funded by: The Health Foundation’s grant to the University of Cambridge for The Healthcare Improvement Studies Institute
                Funded by: Medical Research Council , doi 10.13039/501100000265;
                Award ID: MR/N022556/1
                Funded by: NHS Lothian Sexual Health and Blood Borne Virus Programme Fund
                Award ID: R46498–R46499
                Categories
                Research Article
                Research Article
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.7 mode:remove_FC converted:15.09.2021

                Obstetrics & Gynecology
                health services research,qualitative research,teleconsultation/telehealth,termination of pregnancy,termination of pregnancy: medical,women’s experiences

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