Putting the power in patients' hands: a comparison of person-centered abortion care between no-test telemedicine abortion and clinic-based medication abortion

Objectives The delivery of medication abortion via telehealth has increased substantially since the start of the COVID-19 pandemic. To examine women’s experience of abortion care, we evaluated the differences between no-test telemedicine abortion (NTTA) and clinic-based medical abortion (CBMA) using a validated person-centered abortion care (PAC) scale at a single academic center. Methods We used a 28-item US-based validated PCAC survey. Eligible patients were aged 18–49 who had had a medication abortion up to and including 77 days gestational age between 2018-2022. NTTA patients used telehealth service delivery with no exam or ultrasound while CBMA patients had clinic-based exams and ultrasounds. In total, there were 998 eligible patients, of which 182 individuals completed the survey. The PAC scores were standardized to a 100-point scale. Higher PAC scores indicate higher person-centered care. Analyses included t-tests to assess differences in mean PAC score between the two care models for each question and in total. Results Of the 182 individuals, 45 were NTTA (24.7%) and 137 were CBMA (75.3%). The mean total PAC score was statistically significantly higher for the NTTA group compared to CBMA (92.7 vs 86.2, p=0.0014). When broken down by question, there were statistically higher PAC scores for NTTA compared to CBMA within the domains of dignity and respect, privacy, autonomy, communication, supportive care, and trust. Conclusions No-test telemedicine abortion care appears to be more person-centered across multiple domains than clinic-based medication abortion. Our findings illustrate that patients value telehealth delivery of medication abortion and argues for broader implementation of NTTA. The delivery of medication abortion via telehealth has increased substantially since the start of the COVID-19 pandemic. To examine women’s experience of abortion care, we evaluated the differences between no-test telemedicine abortion (NTTA) and clinic-based medical abortion (CBMA) using a validated person-centered abortion care (PAC) scale at a single academic center. We used a 28-item US-based validated PCAC survey. Eligible patients were aged 18–49 who had had a medication abortion up to and including 77 days gestational age between 2018-2022. NTTA patients used telehealth service delivery with no exam or ultrasound while CBMA patients had clinic-based exams and ultrasounds. In total, there were 998 eligible patients, of which 182 individuals completed the survey. The PAC scores were standardized to a 100-point scale. Higher PAC scores indicate higher person-centered care. Analyses included t-tests to assess differences in mean PAC score between the two care models for each question and in total. Of the 182 individuals, 45 were NTTA (24.7%) and 137 were CBMA (75.3%). The mean total PAC score was statistically significantly higher for the NTTA group compared to CBMA (92.7 vs 86.2, p=0.0014). When broken down by question, there were statistically higher PAC scores for NTTA compared to CBMA within the domains of dignity and respect, privacy, autonomy, communication, supportive care, and trust. No-test telemedicine abortion care appears to be more person-centered across multiple domains than clinic-based medication abortion. Our findings illustrate that patients value telehealth delivery of medication abortion and argues for broader implementation of NTTA.