Changes in Service Delivery Patterns after Introducing Telemedicine Provision of Medical Abortion in Iowa

Daniel Grossman, Ibis Reproductive Health
Kate Grindlay, Ibis Reproductive Health
Todd Buchacker, Planned Parenthood of the Heartland
Joseph E. Potter, University of Texas at Austin
Carl P. Schmertmann, Florida State University

Planned Parenthood of the Heartland began providing medical abortion (MA) via telemedicine in Iowa in 2008. De-identified service delivery data were analyzed for the two years prior to and after telemedicine introduction (n=17,956 abortion encounters). Bivariate and multivariate regression analyses were performed to evaluate service delivery changes as well as the spatial distribution of clients before and after telemedicine introduction. Controlling for age, race, education and whether the client received financial support, the odds of having MA were significantly higher after telemedicine (OR 1.52, 95% CI 1.42-1.62), as were the odds of having an abortion at <13 weeks’ gestation (OR 1.48, 95% CI 1.24-1.77). After telemedicine, the average distance traveled by clients decreased by 3.23 miles (95% CI 1.9-4.6 miles, p<0.001). Women living more than 50 miles away from a surgical abortion clinic were significantly more likely to obtain an abortion and obtain a medical abortion after telemedicine introduction (p=0.005).