History-Based Screening for Medication Abortion Safe and Effective

(Reuters Health) – Screening women for medication abortion eligibility by patient history alone is effective and safe, suggests a new study that included both in-person dispensing and mailed medication.

The analysis of data from nearly 3,800 women in 34 U.S. states, of whom two thirds were screened in person, revealed that 94.8% had a complete abortion and 0.54% had a major abortion-related adverse outcome, such as needing a blood transfusion, surgery or hospital admission, according to the report published in JAMA Internal Medicine.

Effectiveness rates were similar when medications were dispensed in person (95.4%) or mailed (93.3%), the authors note.

“Our study shows that screening patients for medication abortion using patient history instead of ultrasounds or physical exams is safe and effective, said the study’s first author Ushma Upadhyay, an associate professor at the University of California, San Francisco. “This model could increase the number of providers offering this essential care, and ultimately the number of patients who can receive this care.”

“A shift towards history-based screening could expand the provision of abortion care to a variety of primary care providers, including nurse practitioners and physicians in family medicine, adolescent medicine, and internal medicine,” Upadhyay said in an email. “Since many of these clinicians work in rural, low-income, BIPOC and other historically marginalized communities, increasing the types of providers and locations offering abortion services could also lead to more equitable access to abortion care.”

New laws in some parts of the country have made abortion difficult to access, Upadhyay said. “This medication abortion care model should be the standard of care everywhere,” she added.

Between May 2020 and January 2021 Upadhyay and her colleagues recruited U.S. clinics that offered medication abortions using history-based screening for at least some patients to join their study.

The retrospective cohort study included 3,779 patients with eligible abortions, with follow-up data for 2,825 abortions (74.8%), and multiple imputation used to account for missing data.

The researchers’ sample was racially and ethnically diverse and 71% lived in urban areas. Among 2,397 patients with a known abortion outcome 536 (22.4%) were Black, 346 (14.4%) Latin/Hispanic, 1,034 (43.2%) white, 223 (9.3%) multiracial, and 258 (10.8%) unknown.

Most patients, 50.4%, paid for their abortions themselves, followed by 23.3% who were covered by Medicaid, and 20.3% covered by private insurance. For 69.5% of eligible patients, this was their first medication abortion.

Among the 2,397 patients with known outcomes, 2,272 had a complete abortion with no further intervention, and 125 had additional intervention to complete abortion (116 patients) or continuing pregnancy (9 patients) at last contact.

Across the sample, 12 abortions (0.54%) were followed by major abortion-related adverse events, and four patients (0.22%) were treated for ectopic pregnancies, the study team notes. Follow-up identified nine patients (0.40%) who had pregnancy durations of greater than 70 days on the date the mifepristone was dispensed that were not identified at screening.

“By increasing telemedicine, the COVID pandemic provides an important test of how safe and how effective remote prescription of medication abortion is,” said Jenna Nobles, director of the population research center at the University of Wisconsin, Madison, who was not involved in the study. “This study demonstrates that removing in-person requirements for medication abortion prescription will not increase safety risks to those who are pregnant.”

SOURCE: https://bit.ly/3L35J3a and https://bit.ly/3wpUDB5 JAMA Internal Medicine, online March 21, 2022.