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Abortions via 'telemedicine' are safe, effective, Iowa study finds

A controversial abortion method that lets a woman terminate a pregnancy via so-called "telemedicine" is just as effective and acceptable to patients as a face-to-face office visit, a new study finds.
/ Source: contributor

A controversial abortion method that lets a woman terminate a pregnancy via so-called "telemedicine" is just as effective and acceptable to patients as a face-to-face office visit, a new study finds.

Three-quarters of patients who choose that option said they did not prefer having the doctor in the room during the procedure that allows physicians to remotely supervise administration of the pregnancy-ending drug RU-486.

Ninety-four percent of the women who chose telemedicine reported that they were "very satisfied" with the procedure, and researchers found that women who received "virtual" counseling had no more complications than those who had office visits, according to the new report published in the latest edition of the journal Obstetrics and Gynecology.

"I think that our study shows that the telemedicine model is being provided quite safely in Iowa, with identical outcomes as face-to-face visits,” said the study’s lead author, Dr. Daniel Grossman, an assistant clinical professor in the department of obstetrics and gynecology at the University of California, San Francisco, and a senior associate with Ibis Reproductive Health, a non-profit research organization based in Oakland, Calif.

“Also, this is something women really like," he added.

The report is among the first to study the effects of telemedicine abortions, which have been increasing even as they've been banned by new laws passed in at least five states.

Grossman and his colleagues followed 578 Iowa women who came to Planned Parenthood clinics seeking to terminate a pregnancy with RU-486:  223 of the patients signed up for counseling via telemedicine while the other 226 opted for face-to-face visits. An Iowa clinic network, Planned Parenthood of the Heartland, has offered some abortions via telemedicine since 2008 in order to expand the service to women earlier in pregnancy and to those who lived in rural areas without abortion providers.

Even though termination with RU-486 requires no surgery, most states require that a physician “provide” the medical abortion, which means that a doctor must personally counsel each patient before doling out medication. A small percentage of states allow the medication to be dispensed by nurse practitioners and other health mid-level providers.

The women received ultrasound at the clinic to determine the gestational age of the fetus before speaking with a physician either in person or virtually. Medical termination was successful in 99 percent of the telemedicine patients as compared to 97 percent of those who had face-to-face counseling. There was no significant difference when it came to complications between the two groups of women.

Telemedicine patients were more likely to report satisfaction with their care than those receiving face-to-face counseling. Still, 25 percent of the telemedicine patients said afterward that they would have preferred being in the same room with their doctor.

The practice has sparked outrage among anti-abortion advocates who claim that telemedicine makes abortion too easy and that not having a doctor on site could endanger womens' health.

Cheryl Sullenger, senior policy adviser for Operation Rescue, has called the procedure "a push-button abortion pill scheme that denies women access to physical examinations by licensed physicians and leaves them to deal with the painful multi-day abortion process at home without access to a licensed physician in the event of emergencies."

So far, five states — Arizona, Kansas, North Dakota, Nebraska and Tennessee — have passed laws limiting telemedicine abortions, according to the Guttmacher Institute.

So-called medical abortions using RU-486, the drug mifepristone, have been available since the U.S. Food and Drug Administration approved the medication in September 2000. Since then, 1.52 million women have used RU-486 to induce abortions, a just-released FDA report showed.

Through the end of April, 2207 adverse events have been associated with the drug, according to FDA records. They include 14 deaths and 612 hospitalizations. Some 339 patients had blood loss severe enough to require transfusions and 256 infections were reported, including 48 serious infections. FDA officials are quick to point out that it's not clear that the drug caused any of those conditions and they told that these reports generated no new "safety signals" regarding RU-486.

Medical ethicist Arthur Caplan suggests that the legislative pushback against this use of telemedicine has more to do with opposition to abortion in general than with a concern for the safety of women.

“Unless these groups have some broader heartburn over the notion of rural areas getting access to doctors by video, I don’t think this is in any way a serious complaint,” said Caplan, a frequent contributor to “Clearly we don’t have enough primary care providers. One way to solve this is through telemedicine. We don’t want to be attacking that, we probably want to be celebrating it.”

But gynecologic surgeon Dr. Morris Wortman said that telemedicine may depersonalize a delicate and emotionally fraught procedure.

“One thing I learned a long time ago is, just because something can be done doesn’t mean it should be done," said Wortman, a clinical associate professor of gynecology at the University of Rochester School of Medicine and director of the Center for Menstrual Disorders and Reproductive Choice.

"I’ve no doubt it can be done safely. But it removes the element of caring that happens when you have two people in the same room. When a patient in my office breaks down in tears, I can at least hand her a tissue or put my hand on her shoulder for support," he added.

The real solution to the problem is to pass legislation that will allow mid-level providers, such as nurse practitioners, to counsel patients and dispense RU-486 — in person, Wortman said.

“I’m 60 and the majority of pregnant patients who come to my office are far younger than me,” Wortman said. “And for that reason I have two nurse practitioners who work the patients up. They are better able to form a bond with the patients. And I think that is as it should be."