Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.
Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.
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DOI：
10.1111/1471-0528.16668
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Starling J
中科院分区：
文献类型：
--
作者：
Aiken A;Lohr PA;Lord J;Ghosh N;Starling J
目的：比较远程医疗实施无超声药物流产（终止妊娠）前后的效果。群分析。三个主要的堕胎提供者。在两个队列中，妊娠≤69天在家进行药物流产：2020年1月至3月的传统模式（带超声的亲自流产，n = 22 158）和2020年4月至6月的远程医疗混合模式（不带超声的亲自流产或通过远程医疗，n = 29 984，其中18 435人没有进行远程医疗测试）。样本（n = 52 142）占全国提供的所有药物流产的85%。来自电子记录和事件数据库的数据用于比较队列之间的结果，并根据基线差异进行调整。治疗成功，严重不良事件，等待时间，妊娠治疗，可接受性。远程医疗混合模式从转诊到治疗的平均等待时间缩短了4.2天，妊娠≤6周的流产率更高（40%比25%，P < 0.001）。治疗成功率（98.8% vs . 98.2%, P = 0.999）、严重不良事件（0.02% vs . 0.04%, P = 0.557）、异位妊娠发生率（0.2% vs . 0.2%, P = 0.796）在不同模型间差异无统计学意义。在远程医疗-混合模型中，0.04%的孕妇在流产时妊娠超过10周；全部在家中安全完成。在远程医疗-混合模式中，远程医疗的有效性高于现场护理（99.2%对98.1%,P < 0.001）。远程医疗的可接受性很高（96%满意），80%的人表示未来更倾向于远程医疗。药物流产的远程医疗-混合模式，包括无检测远程医疗和无超声治疗，是有效、安全、可接受的，并改善了获得护理的机会。来自5142名妇女的令人信服的证据表明，无需检测的远程医疗流产是安全、有效的，并能改善护理。来自5142名妇女的令人信服的证据表明，无需检测的远程医疗流产是安全、有效的，并能改善护理。这篇文章包括作者的见解，一个视频摘要可在https://vimeo.com/bjog/authorinsights16668
To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine. Cohort analysis. The three main abortion providers. Medical abortions at home at ≤69 days’ gestation in two cohorts: traditional model (in‐person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine‐hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no‐test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally. Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences. Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability. Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine‐hybrid model and more abortions were provided at ≤6 weeks’ gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine‐hybrid model, 0.04% were estimated to be over 10 weeks’ gestation at the time of the abortion; all were completed safely at home. Within the telemedicine‐hybrid model, effectiveness was higher with telemedicine than in‐person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine. A telemedicine‐hybrid model for medical abortion that includes no‐test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care. Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care. Compelling evidence from 52 142 women shows no‐test telemedicine abortion is safe, effective and improves care. This article includes Author Insights, a video abstract available at https://vimeo.com/bjog/authorinsights16668
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影响因子：
8.1
作者：
Gambir K;Garnsey C;Necastro KA;Ngo TD
通讯作者：
Ngo TD
DOI：
10.1111/j.1471-0528.2010.02753.x
发表时间：
2011-01-01
影响因子：
5.8
作者：
Bracken, H.;Clark, W.;Winikoff, B.
通讯作者：
Winikoff, B.
影响因子：
3.3
作者：
Moreau C;Shankar M;Glasier A;Cameron S;Gemzell-Danielsson K
通讯作者：
Gemzell-Danielsson K
影响因子：
3.3
作者：
Erlank, Chelsey Porter;Lord, Jonathan;Church, Kathryn
通讯作者：
Church, Kathryn
DOI：
10.1034/j.1600-0412.2002.810713.x
发表时间：
2002-07-01
影响因子：
4.3
作者：
Mol, BWJ;van der Veen, F;Bossuyt, PMM
通讯作者：
Bossuyt, PMM