Women's and providers' perspectives on telemedicine provision of medication abortion

In states requiring physicians to dispense mifepristone, the small number of providers offering the method limits its uptake. In 2008, Planned Parenthood of the Heartland in Iowa began providing medication abortion via telemedicine at clinics without an on-site physician. We recently demonstrated that telemedicine provision was equally safe and effective as face-to-face physician provison, and acceptability may be higher among telemedicine clients. The purpose of this study was to evaluate qualitatively women's and providers' experiences with telemedicine provision of medication abortion.

Between October 2009-February 2010, in-depth interviews were conducted at Planned Parenthood clinics with 26 women receiving medication abortion services (21 telemedicine clients and 5 face-to-face clients), and 16 providers (2 physicians, 2 nurses, 6 counselors/educators, 5 center managers, and 1 study coordinator). Data were analyzed qualitatively for themes related to acceptability of the telemedicine service delivery model.

Women and providers cited numerous advantages of telemedicine, including decreased travel for women and physicians, greater flexibility and availability of locations and appointment times, and fewer cancelations due to weather compared to face-to-face provision. Overall, women were generally positive or indifferent about having the conversation with the doctor take place via telemedine, with most reporting it felt private/secure and in some cases even more comfortable than a face-to-face visit. However, other women had privacy concerns or preferred being in the same room with the physician, highlighting the importance of informing women about their options so they can choose their preferred model. Interviews also highlighted several ways the service could be improved.