implementation of telemedicine preoperative evaluations for patients obtaining surgical abortion and requiring cervical preparation through 18 weeks 0 days gestation
Awarded 2018
Complex Family Planning Fellowship Research
Melissa Matulich, MD
University of California, Davis

Patients living in rural communities face access issues to sub-specialty care and abortion is no exception. Telemedicine has become an innovative strategy to address such access disparities and we aimed to develop a preoperative telemedicine program for our surgical abortion patient population.
We performed an implementation science study documenting development and operation of a new telemedicine program offering preoperative evaluations via secure videoconferencing to patients seeking surgical abortions from 12 to 18 weeks by ultrasonography and requiring cervical preparation. Secondarily, we invited telemedicine and in-person preoperative patients to answer structured questions evaluating their experience.
Implementation started in August 2017 and required eight months of multidisciplinary meetings. The most significant barrier to efficient program utilization was establishing an institutionally approved method for signing consents electronically. From March 2018 through March 2019, we evaluated 200 patients referred for abortion and needing cervical preparation from 12 to 18 weeks gestation. Of these 200 patients, 119 did not meet all eligibility criteria for a telemedicine visit, most commonly due to inability to obtain ultrasound documentation of gestational age and/or placental characterization in patients with prior cesarean delivery (n=89/119 [75%]). Eighty-one (41%) patients met all telemedicine eligibility criteria and 43 scheduled telemedicine visits. Thirty-eight (88%) of the 43 scheduled visits were successful; 21 (55%) experienced no or minor technical difficulties. Four patients that completed a telemedicine visit ultimately did not have a procedure. Of the 34 telemedicine and 108 in-person visit patients who completed surveys, 31 (91%) and 91 (84%), respectively, were “highly satisfied” with their preoperative appointment (p=0.4) and none were dissatisfied.
In conclusion, a multidisciplinary team is essential for implementation of a preoperative telemedicine program for surgical abortions as there are institutional and technological challenges. However, once established, this program is feasible and valuable as evidenced by high patient satisfaction.