远程医疗提供的无检测药物流产（终止妊娠）的有效性、安全性和可接受性：一项全国性队列研究。
Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study.
机构信息
LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA.
British Pregnancy Advisory Service, Stratford upon Avon, UK.
出版信息
BJOG. 2021 Aug;128(9):1464-1474. doi: 10.1111/1471-0528.16668. Epub 2021 Mar 24.
OBJECTIVE
To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.
DESIGN
Cohort analysis.
SETTING
The three main abortion providers.
POPULATION OR SAMPLE
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.
METHODS
Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.
MAIN OUTCOME MEASURES
Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.
RESULTS
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.
CONCLUSIONS
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.
TWEETABLE ABSTRACT
Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.
目的
比较通过远程医疗实施无超声医学流产（终止妊娠）前后的结局。
设计
队列分析。
设置
三个主要的堕胎提供者。
人群或样本
在两个队列中在家进行的妊娠<69 天的药物流产：传统模式（面对面+超声，n=22158），时间为 2020 年 1 月至 3 月；与远程医疗混合模式（面对面或无超声远程医疗，n=29984，其中 18435 人进行了无测试远程医疗），时间为 2020 年 4 月至 6 月。样本（n=52142）占全国所有药物流产的 85%。
方法
使用电子记录和事件数据库的数据，比较队列之间的结果，并对基线差异进行调整。
主要观察指标
治疗成功率、严重不良事件、等待时间、治疗时的妊娠时间、可接受性。
结果
远程医疗混合模式的平均等待时间从转诊到治疗缩短了 4.2 天，并且在≤6 周的妊娠时间内提供了更多的流产（40%比 25%，P<0.001）。治疗成功率（98.8%比 98.2%，P>0.999）、严重不良事件（0.02%比 0.04%，P=0.557）和异位妊娠发生率（0.2%比 0.2%，P=0.796）在两种模式之间没有差异。在远程医疗混合模式中，估计有 0.04%的人在流产时已超过 10 周妊娠；所有病例均在家中安全完成。在远程医疗混合模式中，远程医疗比面对面护理更有效（99.2%比 98.1%，P<0.001）。远程医疗的可接受性很高（96%的人满意），80%的人表示将来更倾向于远程医疗。
结论
一项包含无测试远程医疗和无超声治疗的远程医疗混合模式用于药物流产是有效、安全、可接受的，并改善了医疗服务的可及性。
推文摘要
来自 52142 名女性的有力证据表明，无测试远程医疗流产是安全、有效且改善了护理。
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