Remote Options for Medication Abortion: Improving Patient Care During and After the Covid-19 Crisis

The COVID-19 pandemic has shifted primary care and other practices towards remote care and telemedicine options to minimize viral exposure. Although in-person visits are sometimes indispensable, research shows that telemedicine can expand access to vital services without sacrificing patient-centered care. Medication abortion is an essential, time-sensitive service that is particularly well-suited to telemedicine provision, including in primary care settings. Decades of clinical research and practice guidelines from core medical societies affirm the safety and efficacy of providing medication abortion remotely. Neither FDA nor professional guidelines require sonography for medication abortion, and research shows that necessary clinical assessments can be achieved without ultrasound. New practice guidelines recommend against Rh testing for abortions under 8 weeks of pregnancy and rely on patient history for those provided from 8 to 11 weeks. As primary care providers, we can and should provide high-quality, low-risk abortion care for patients without point-of-care exams and labs. This discussion includes a detailed checklist for providing such remote-care medication abortion in a variety of settings. Such strategies will allow more clinicians to offer this essential care both during and after the Covid-19 crisis.https://deepblue.lib.umich.edu/bitstream/2027.42/155399/1/Stein main article.pd

Integration of Medication Abortion into Primary Care Practice and Teaching: An Intersection of Patient Care, Reproductive Justice and Advocacy

Presentation: 50:45 Note: PowerPoint slides are located at the bottom of this page

Medication Abortion: A Sample Protocol for Increasing Access During a Pandemic and Beyond

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From Reproductive Rights to Reproductive Justice

This month the Social Medicine Journal of-fers readers the text of the Annual Harold Wise Memorial Lecture held on June 13, 2017 at the Department of Family and Social Medicine at Montefiore Medical Center. Harold Wise was the founder of the Residency Program in Social Medicine and the award recognizes a faculty member who best represents the values of the Residency Progra

The Visit Before the Morning After: Barriers to Preprescribing Emergency Contraception

BACKGROUND Research suggests that while advance prescription of emergency contraception (EC) increases women’s access, this prescribing model is rarely used. The present study sought to explore attitudes towards EC among patients and physicians, with the goal of understanding potential barriers to advance prescription. METHODS Qualitative, semistructured interviews were conducted with patients and clinicians in a New York City family practice clinic. RESULTS Using qualitative interviews, we found that attitudes towards EC among patients and clinicians are complex. Both groups of participants reported favorable attitudes towards EC. There was general agreement that physicians should take a proactive role in educating patients about the method. A notable minority in each group described substantial reservations, however, especially regarding the potential for EC abuse. Such attitudes emerged mainly in the context of discussions about advance prescription. Advance prescription was viewed as greatly facilitating access to EC, but some patients and clinicians feared that ready access would encourage irresponsible sex. Some participants condoned the occasional, accidental, or emergency use of EC; however, habitual use, or the plan not to plan for sex, was viewed as morally indefensible. CONCLUSION Findings suggest that even when attitudes towards EC are generally favorable, some physicians and patients have substantial reservations about advance prescription. Education and dialogue are needed to overcome these reservations

Mailing abortion pills does not delay care: A cohort study comparing mailed to in-person dispensing of abortion medications in the United States.

OBJECTIVE: Given the substantial barriers to abortion access in the United States, many clinics now mail patients abortion medications. We examined whether dispensing the medications by mail prolonged time to medication use. STUDY DESIGN: We analyzed data from no-test medication abortions with medication provided either by mail or in a clinic from 11 United States clinics from February 2020 to January 2021. We examined mean number of days from patients first contact with the clinic to mifepristone ingestion, its two-component intervals (first contact to medication dispensing and dispensing to mifepristone ingestion), and pregnancy duration at mifepristone ingestion. We used Poisson regression to compare mean outcomes across three dispensing methods: in-person, mailed from the clinic, and mailed from a mail-order pharmacy. RESULTS: Among the 2600 records, patients took mifepristone on average at 49 days of gestation (95% CI, 47-51) and 7 days (95% CI, 4-10) after first contact. Mean time from first contact to mifepristone ingestion was 6 days when medications were dispensed in-person and 9 days when mailed (p = 0.38). While time from first contact to dispensing was similar across methods (6 days in-person, 5 days mailed, p = 0.77), more time elapsed from dispensing to mifepristone ingestion when medications were mailed (4 days from clinic, 5 days from mail-order pharmacy) versus dispensed in-person (0.3 days, p < 0.001). Time to mifepristone ingestion was shorter with higher pregnancy duration. Pregnancy duration at ingestion was similar across methods (48 days in-person, 50 days mailed). CONCLUSIONS: Mailing medications did not significantly prolong time from patients first contact with the clinic to mifepristone ingestion or increase pregnancy duration at mifepristone ingestion. IMPLICATIONS: Abortion providers should offer a range of medication abortion dispensing options, prioritizing patient preference

Medication Abortion: A Sample Protocol for Increasing Access During a Pandemic and Beyond

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