From Ibis Reproductive Health, Oakland, California, and Cambridge, Massachusetts; the Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California; Planned Parenthood of the Heartland, Des Moines, Iowa; Abortion Access Project, Cedar Rapids, Iowa.
Obstet Gynecol. 2011 Aug;118(2 Pt 1):296-303. doi: 10.1097/AOG.0b013e318224d110.
To estimate the effectiveness and acceptability of telemedicine provision of early medical abortion compared with provision with a face-to-face physician visit at a Planned Parenthood affiliate in Iowa.
Between November 2008 and October 2009, we conducted a prospective cohort study of women obtaining medical abortion by telemedicine or face-to-face physician visits. We collected clinical data, and women completed a self-administered questionnaire at follow-up. We also compared the prevalence of reportable adverse events between the two service delivery models among all patients seen between July 2008 and October 2009.
Of 578 enrolled participants, follow-up data were obtained for 223 telemedicine patients and 226 face-to-face patients. The proportion with a successful abortion was 99% for telemedicine patients (95% confidence interval [CI] 96-100%) and 97% for face-to-face patients (95% CI 94-99%). Ninety-one percent of all participants were very satisfied with their abortion, although in multivariable analysis, telemedicine patients had a higher odds of saying they would recommend the service to a friend compared with face-to-face patients (odds ratio, 1.72; 95% CI 1.26-2.34). Twenty-five percent of telemedicine patients said they would have preferred being in the same room with the doctor. Younger age, less education, and nulliparity were significantly associated with preferring face-to-face communication. There was no significant difference in the prevalence of adverse events reported during the study period among telemedicine patients (n = 1,172) (1.3%; 95% CI 0.8-2.1%) compared with face-to-face patients (n = 2,384) (1.3%; 95% CI 0.9-1.8%) (82% power to detect difference of 1.3%).
Provision of medical abortion through telemedicine is effective and acceptability is high among women who choose this model.
II.
评估爱荷华州计划生育协会通过远程医疗提供早期药物流产与面对面就诊提供药物流产的效果和可接受性。
2008 年 11 月至 2009 年 10 月，我们对通过远程医疗或面对面就诊获得药物流产的女性进行了前瞻性队列研究。我们收集了临床数据，并且女性在随访时完成了自我管理问卷。我们还比较了 2008 年 7 月至 2009 年 10 月期间所有就诊患者中两种服务模式下报告不良事件的发生率。
在 578 名入组参与者中，223 名远程医疗患者和 226 名面对面患者获得了随访数据。远程医疗患者流产成功率为 99%（95%置信区间[CI]96-100%），面对面患者为 97%（95%CI94-99%）。所有参与者中有 91%对流产非常满意，尽管在多变量分析中，与面对面患者相比，远程医疗患者更有可能推荐该服务给朋友（优势比，1.72；95%CI1.26-2.34）。25%的远程医疗患者表示，他们更希望与医生在同一房间内。年龄较小、教育程度较低和未育与更喜欢面对面交流显著相关。在研究期间，远程医疗患者（n=1172）报告的不良事件发生率（1.3%；95%CI0.8-2.1%）与面对面患者（n=2384）（1.3%；95%CI0.9-1.8%）（82%的效力可检测到 1.3%的差异）无显著差异。
通过远程医疗提供药物流产在选择该模式的女性中是有效的，可接受性高。
II 级。
