Use of telemedicine for providing medical abortion

Telemedicine has been used to provide abortion in severalways. The website Women onWeb [1] uses e-mail support to facilitate the provision of medical abortion to women in situations in which safe abortion is not available [2]. Some US clinics offermedical abortions in which the patients see a counselor in the clinic but see the doctor via videoconferencing [3]. Routine ultrasound is usually used to date the pregnancy and determine abortion success in North America but serial quantitative human chorionic gonadotropin (hCG) values can also be used [4]. Because mifepristone is not available in Canada, the usual regimen is methotrexate (50 mg/m intramuscularly or orally) followed by misoprostol (800 μg vaginally) repeated twice 4–12 hours later. This regimen has a similar success rate to that of mifepristone plus misoprostol [5]. We conducted a retrospective chart review of women who underwent medical abortion via telemedicine between May 1, 2012, and May 1, 2013, at Willow Women’s Clinic, Vancouver, Canada. The study was approved by the Research Ethics Board at the University of British Columbia, Vancouver, Canada. To be eligible for a telemedicine abortion at the study clinic, women must live in British Columbia (where the clinic physicians are licensed); have access to a laboratory for timely serum quantitative hCG estimations; and be able to travel to the clinic or to another community facility for surgical completion, if necessary. They see a physician and counselor via Skype (Microsoft Skype Division, Luxembourg City, Luxembourg) videoconferencing for screening, information, and consent. Thewomen go to a local laboratory for hCG tests at initial screening, on the day of the medication, and 1 week later (3 tests). If their hCG level is above 5000mIU/mL, an ultrasound is arranged. Rhesus-negative women are offered anti-D; this is arranged through a local facility. Themedications are couriered or a prescription is faxed to a local pharmacy. Women have a follow-up videoconferencing appointment to discuss their blood test results and any reactions to the medications. If their hCG level has fallen by 80% in 1 week, women are informed that the abortion is complete and that they require no further follow-up. If additional medication, surgery, or further blood tests are required, they are arranged by the clinic. Between May 2012 and May 2013, 11 women underwent medical abortion via telemedicine at the study clinic (Table 1). One woman experienced spontaneous abortionwith nomedication, 1woman required surgical completion, and 1 woman was lost to follow-up; the other women experienced uneventful medical abortion. During the study period, a further 29 women were seen in-clinic for their first visit and ultrasound, with scheduled videoconferencing for follow-up; in addition, 1858 women made regular in-clinic visits. The main innovation with regard to this program is that we see patients in their own homes using their own technology (a computer or smart phone), yet provide the same physician and counseling services as we do in the clinic. This method of providing abortion via telemedicine is feasible in the present setting and may improve access to abortion.