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Safety and effectiveness of medication abortion provided via - - PowerPoint PPT Presentation
Safety and effectiveness of medication abortion provided via - - PowerPoint PPT Presentation
Safety and effectiveness of medication abortion provided via telemedicine at Planned Parenthood in four U.S. states Julia E. Kohn, PhD, MPA Planned Parenthood Federation of America AcademyHealth Annual Research Meeting June 4, 2019 |
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Acknowledgments
- Co-authors: Jennifer L. Snow, MSc; Hannah R. Simons,
DrPH; Jane W. Seymour, MPH; Terri-Ann Thompson, PhD; Daniel Grossman, MD
- Affi
filiates: PP Great Northwest and the Hawaiian Islands and PP of the Rocky Mountains
- Anonymous Funder
- Patients
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Telemedicine Continuum
Consultation Connecting providers to each other in different locations Site-to-Site Connecting a provider to a patient in a different health center Direct-to- Patient Connecting a provider to a patient wherever they are
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Background
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To assess outcomes of telemedicine medication abortion compared to standard medication abortion at Planned Parenthood health centers in four states
- Ongoing pregnancy
- Receipt of/referral for aspiration within
45 days
- Clinically-significant adverse events
Objective & Study Outcomes
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Data Sources
Retrospective cohort study using routinely-collected clinical data for patients at 26 Planned Parenthood centers in four states from April 2017–March 2018: Planned Parenthood health center-specific EHR systems Adverse event reports submitted through internal surveillance system
AIMS
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- Compared outcomes between telemedicine
and standard medication abortion groups:
○ Unit of analysis = abortion episode ○ Regression accounting for gestational age
and health center clustering
○ Frequencies and rates of
clinically-significant AEs
○ Sensitivity analyses applying published
rates of ongoing pregnancy and aspiration
Analysis
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Sample
5,952
patients received a medication abortion
5,214
standard MAB
738
teleMAB
4,011 (75%)
followed up with health center within 45 days
445 (60%)
followed up with health center within 45 days
4,456 (75%)
patients with ascertainable outcomes
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- State: Most (75%) from WA or NV (12%)
- Age: 56% in 20s (mean=27.5, SD=0.8)
- Race/ethnicity: 53% White, 14% Latina, 12%
API; 11% Black
- GA: mean=49 days (SD=0.11)
- Parity: 49% were parous
Patient Characteristics (N=5,952)
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Ongoing Pregnancy & Aspiration*
All (n=4,456) Standard (n=4,011) TeleMAB (n=445) AOR (95%CI)
Ongoing pregnancy
73 (1.6%) 71 (1.8%) 2 (0.5%) 0.23 (0.14–0.39)
Receipt or referral for aspiration
188 (4.2%) 182 (4.5%) 6 (1.4%) 0.28 (0.17–0.46)
*only includes patients with follow-up data within 45 days
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Sensitivity Analysis
All (N=5,952) Standard (n=5,214) TeleMAB (n=738) OR* (95%CI) Ongoing Pregnancy 86 (1.4%) 82 (1.6%) 4 (0.5%) 0.34 (0.13–0.90) Receipt/ referral for aspiration 273 (4.0%) 222 (4.3%) 16 (2.2%) 0.50 (0.30–0.83)
*Estimated outcomes applying rates from Chen et al. (2015) to patients LTFU
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Adverse Events
All (N=5,952) Standard (n=5,214) TeleMAB (n=738) Any major AE or ED visit with treatment 17 (0.29%) 16 (0.31%) 1 (0.14%) Any major AE 8 (0.13%) 7 (0.13%) 1 (0.14%) Hospital admission 4 (0.1%) 4 (0.1%)
- Surgery
2 (<0.1%) 2 (<0.1%)
- Transfusion
5 (0.1%) 4 (0.1%) 1 (0.1%) ED Visit treatment (minor AE) 9 (0.15%) 9 (0.17%)
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Limitations
- Loss-to-follow-up and differences by group
- Patients may have sought care at other providers
- r hospitals
- Uneven distribution across states; unable to
conduct comparisons by state
- Used referral for aspiration for two sites and
cannot be certain that all received procedure
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Conclusions
- Findings support existing evidence that teleMAB
results in comparable outcomes to standard medication abortion.
- Differences in observed rates may be due to
differential follow up.
- To the extent that state bans on telemedicine for
abortion rest upon arguments of improved patient safety, research findings do not support such contentions.
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