Changes in service delivery patterns after introduction of telemedicine provision of medical abortion in Iowa

Abstract

Objectives: We assessed the effect of a telemedicine model providing medical abortion on service delivery in a clinic system in Iowa.

Methods: We reviewed Iowa vital statistic data and billing data from the clinic system for all abortion encounters during the 2 years prior to and after the introduction of telemedicine in June 2008 (n = 17,956 encounters). We calculated the distance from the patient's residential zip code to the clinic and to the closest clinic providing surgical abortion.

Results: The abortion rate decreased in Iowa after telemedicine introduction, and the proportion of abortions in the clinics that were medical increased from 46% to 54%. After telemedicine was introduced, and with adjustment for other factors, clinic patients had increased odds of obtaining both medical abortion and abortion before 13 weeks' gestation. Although distance traveled to the clinic decreased only slightly, women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction.

Conclusions: Telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion.

FIGURE 1—

Change in total number of abortions by residential zip code for 2 years before (June 20, 2006–June 24, 2008) and after (June 25, 2008–June 30, 2010) telemedicine was introduced in Planned Parenthood of the Heartland clinics in Iowa. Note. Mapping results are smoothed. A, B, C, and D = clinics that provide surgical abortion (solid and broken rings indicate distances of 25 and 50 miles, respectively). Yellow squares = clinics that intermittently offered medical abortion before telemedicine was introduced when a doctor traveled to the clinic and later became telemedicine sites. Yellow triangles = clinics that began offering medical abortion after telemedicine was introduced.

FIGURE 2—

Change in number of abortions by residential zip code for 2 years before (June 20, 2006–June 24, 2008) and after (June 25, 2008–June 30, 2010) telemedicine was introduced in Planned Parenthood of the Heartland clinics in Iowa that were (a) surgical and (b) medical. Note. Mapping results are smoothed. A, B, C, and D = clinics that provide surgical abortion (solid and broken rings indicate distances of 25 and 50 miles, respectively). Yellow squares = clinics that intermittently offered medical abortion before telemedicine was introduced when a doctor traveled to the clinic and later became telemedicine sites. Yellow triangles = clinics that began offering medical abortion after telemedicine was introduced.