This study explores patients' experiences and perspectives on obtaining telemedicine medication abortions (TeleMAB) through their primary care health system. Researchers conducted in-depth phone interviews with 14 English, Spanish, and/or Portuguese-speaking patients, ranging in age from 26 to 42, who received a TeleMAB between July 2020 and December 2021 from a large primary care safety-net community health system in Massachusetts. Thirteen of the interviewees provided demographic information. All 13 identified as female, and 10 had children between 8 months and 15 years old. Six (42.8%) identified as African American/Black, three (21.4%) as Asian/Pacific Islander/Native Hawaiian, two (14.3%) as White and Black, one (7%) as White, and one as Hispanic/Latino.
Three main themes emerged from the interviews. First, participants found the process of obtaining TeleMAB through primary care to be easy. The medication was delivered as expected, and the provider counseling and clear instructions made them feel well prepared. They were comfortable with their primary care network; while some participants received care from someone other than their regular primary care doctor, they were able to trust another provider from the network. Second, telemedicine allowed them to receive abortion care at home or wherever they felt safe and comfortable. This decreased anxiety as well as disruptions to their daily lives. Third, primary care normalizes abortion care. An abortion clinic might feel unfamiliar and unknown, whereas the primary care relationship is established and familiar. A primary care physician can provide abortion care in the context of the patients' other medical concerns and history. Overall, the participants in this study expressed positive feelings about their TeleMAB experience centering around these three themes.
What We Know: Throughout the United States, laws restricting access to reproductive health care, and especially access to abortion, continue to be introduced and enacted. Since the U.S. Supreme Court overturned Roe v. Wade with its June 2022 decision in Dobbs v. Jackson Women's Health Organization, almost half of all U.S. states have severely restricted or banned abortion care altogether. This disproportionately affects underserved and minority people, who make up about 70% of those who obtain abortion services and for whom primary care is critical. Prior to Dobbs, few primary care practices offered abortion, yet abortion in primary care settings, including direct-to-patient telemedicine medication abortion (TeleMAB), in which pills are mailed to patients and medical guidance is provided remotely, has been shown to be a safe, feasible, and effective option.
What This Study Adds: Although research has shown that administering TeleMAB by primary care is safe and efficient, no previous study has evaluated patients' experiences obtaining TeleMAB through their primary care health system. Overall, the participants interviewed for this study felt that using TeleMAB services through their primary care health system was a positive and easy experience. This supported their ability to exercise control over their treatment, allowed them autonomy and flexibility, and decreased barriers they may have experienced with in-clinic care. Many said they use primary care for pregnancy-related health care needs, and they valued receiving abortion care from their regular clinicians within the context of their ongoing care for other medical concerns. Primary care practices can integrate TeleMAB services to decrease care silos, normalize abortion as a part of comprehensive primary care, and improve access for many people of reproductive age through remote care.
Telemedicine Abortion in Primary Care: An Exploration of Patient Experiences
Amy Tressan, MD, et al.
Department of Family Medicine, Planned Parenthood of Orange and San Bernardino Counties, Anaheim, CA
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