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Research ArticleOriginal Research

Remote Delivery in Reproductive Health Care: Operation of Direct-to-Patient Telehealth Medication Abortion Services in Diverse Settings

Anna E. Fiastro, Sajal Sanan, Elizabeth Jacob-Files, Elisa Wells, Francine Coeytaux, Molly R. Ruben, Ian M. Bennett and Emily M. Godfrey
The Annals of Family Medicine July 2022, 2821; DOI: https://doi.org/10.1370/afm.2821
Anna E. Fiastro
1Department of Family Medicine, University of Washington, Seattle, Washington
MPH, MEM
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  • For correspondence: afiastro@uw.edu
Sajal Sanan
1Department of Family Medicine, University of Washington, Seattle, Washington
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Elizabeth Jacob-Files
1Department of Family Medicine, University of Washington, Seattle, Washington
MA, MPH
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Elisa Wells
2Plan C, Washington, DC
MPH
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Francine Coeytaux
2Plan C, Washington, DC
MPH
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Molly R. Ruben
1Department of Family Medicine, University of Washington, Seattle, Washington
MPH
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Ian M. Bennett
1Department of Family Medicine, University of Washington, Seattle, Washington
MD, PhD
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Emily M. Godfrey
1Department of Family Medicine, University of Washington, Seattle, Washington
MD, MPH
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Abstract

PURPOSE Established models of reproductive health service delivery were disrupted by the coronavirus disease 2019 (COVID-19) pandemic. This study examines rapid innovation of remote abortion service operations across health care settings and describes the use of telehealth consultations with medications delivered directly to patients.

METHODS We conducted semi-structured interviews with 21 clinical staff from 4 practice settings: family planning clinics, online medical services, and primary care practices-independent or within multispecialty health systems. Clinicians and administrators described their telehealth abortion services. Interviews were recorded, transcribed, and analyzed. Staff roles, policies, and procedures were compared across practice settings.

RESULTS Across all practice settings, telehealth abortion services consisted of 5 operational steps: patient engagement, care consultations, payment, medication dispensing, and follow-up communication. Online services and independent primary care practices used asynchronous methods to determine eligibility and complete consultations, resulting in more efficient services (2-5 minutes), while family planning and health system clinics used synchronous video encounters requiring 10-30 minutes of clinician time. Family planning and health system primary care clinics mailed medications from clinic stock or internal pharmacies, while independent primary care practices and online services often used mailorder pharmacies. Online services offered patients asynchronous follow-up; other practice settings scheduled synchronous appointments.

CONCLUSIONS Rapid innovations implemented in response to disrupted in-person reproductive health care included remote medication abortion services with telehealth assessment/follow-up and mailed medications. Though consistent operational steps were identified across health care settings, variation allowed for adaptation of services to individual sites. Understanding remote abortion service operations may facilitate dissemination of a range of patient-centered reproductive health services.

Key words:
  • telehealth
  • telemedicine
  • service operation
  • remote service delivery
  • abortion
  • medication abortion
  • pregnancy
  • unwanted
  • pregnancy
  • unplanned
  • Received for publication August 27, 2021.
  • Revision received January 7, 2022.
  • Accepted for publication January 12, 2022.
  • © 2022 Annals of Family Medicine, Inc.
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The Annals of Family Medicine: 23 (2)
The Annals of Family Medicine: 23 (2)
Vol. 23, Issue 2
Mar/April 2025
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Remote Delivery in Reproductive Health Care: Operation of Direct-to-Patient Telehealth Medication Abortion Services in Diverse Settings
Anna E. Fiastro, Sajal Sanan, Elizabeth Jacob-Files, Elisa Wells, Francine Coeytaux, Molly R. Ruben, Ian M. Bennett, Emily M. Godfrey
The Annals of Family Medicine Jul 2022, 2821; DOI: 10.1370/afm.2821

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Remote Delivery in Reproductive Health Care: Operation of Direct-to-Patient Telehealth Medication Abortion Services in Diverse Settings
Anna E. Fiastro, Sajal Sanan, Elizabeth Jacob-Files, Elisa Wells, Francine Coeytaux, Molly R. Ruben, Ian M. Bennett, Emily M. Godfrey
The Annals of Family Medicine Jul 2022, 2821; DOI: 10.1370/afm.2821
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Keywords

  • telehealth
  • telemedicine
  • service operation
  • remote service delivery
  • abortion
  • medication abortion
  • pregnancy
  • unwanted
  • unplanned

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