Telemedicine for the provision of medication abortion to pregnant people at up to twelve weeks of pregnancy: a systematic literature review and meta-analysis

被引:1
作者
Cely-Andrade, Leonardo [1 ]
Cardenas-Garzon, Karen [1 ]
Enriquez-Santander, Luis Carlos [1 ]
Saavedra-Avendano, Biani [2 ]
Avendano, Guillermo Antonio Ortiz [3 ]
机构
[1] Profamilia, Bogota, Colombia
[2] Ipas Latin Amer & Caribbean, Mexico City, Mexico
[3] Ipas Latin Amer & Caribbean, Ipas, NC USA
关键词
Medication abortion; Telemedicine; Standard care; First trimester; Effectiveness; Adverse effects; Acceptability; Satisfaction; Systematic review; Meta-analysis; ORAL MISOPROSTOL; UNITED-STATES; ACCEPTABILITY; SATISFACTION; EXPERIENCE; SERVICE; SAFETY; HOME;
D O I
10.1186/s12978-024-01864-4
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
BackgroundTelemedicine represents an important strategy to facilitate access to medication abortion (MAB) procedures, reduces distance barriers and expands coverage to underserved communities. The aim is evaluating the self-managed MAB (provided through telemedicine as the sole intervention or in comparison to in-person care) in pregnant people at up to 12 weeks of pregnancy.MethodsA literature search was conducted using electronic databases: MEDLINE, Embase, Cochrane (Central Register of Controlled Trials and Database of Systematic Reviews), LILACS, SciELO, and Google Scholar. The search was based on the Population, Intervention, Comparison, Outcome, and Study Design (PICOS) framework, and was not restricted to any years of publication, and studies could be published in English or Spanish. Study screening and selection, risk of bias assessment, and data extraction were performed by peer reviewers. Risk of bias was evaluated with RoB 2.0 and ROBIS-I. A narrative and descriptive synthesis of the results was conducted. Meta-analyses with random-effects models were performed using Review Manager version 5.4 to calculate pooled risk differences, along with their individual 95% confidence intervals. The rate of evidence certainty was based on GRADE recommendations.Results21 articles published between 2011 and 2022 met the inclusion criteria. Among them, 20 were observational studies, and 1 was a randomized clinical trial. Regarding the risk of bias, 5 studies had a serious risk, 15 had a moderate risk, and 1 had an undetermined risk. In terms of the type of intervention, 7 compared telemedicine to standard care. The meta-analysis of effectiveness revealed no statistically significant differences between the two modalities of care (RD = 0.01; 95%CI 0.00, 0.02). Our meta-analyses show that there were no significant differences in the occurrence of adverse events or in patient satisfaction when comparing the two methods of healthcare delivery.ConclusionTelemedicine is an effective and viable alternative for MAB, similar to standard care. The occurrence of complications was low in both forms of healthcare delivery. Telemedicine services are an opportunity to expand access to safe abortion services. Globally, unsafe abortion causes 47,000 deaths and 5 million sexual and reproductive dysfunctions in young pregnant people due to complications of the procedure. This practice is related to barriers to accessing safe abortion services secondary to health system limitations and inequities in the distribution of resources.Telemedicine has proven to be an efficient care alternative to reduce distancing gaps, decrease waiting time and rationalize the costs derived from the procedure. Consequently, several health systems in the world use this model with differences in treatment schemes, weeks of gestation, pregnancy confirmation methods and measurement of reported outcomes. For this reason, evaluating the effectiveness and safety of self-managed medication abortion (MAB) by telemedicine is a support for decision makers who consider implementing or expanding remote care services.This systematic review integrated studies that evaluated MAB only by Telemedicine or in comparison with standard care on pregnant people with 12 weeks gestation or less. Available studies until January 2023 were chosen. Screening and selection of studies, data extraction, and risk of bias assessment were performed by expert reviewers. Aspects such as the effectiveness, safety, and satisfaction of the procedure, among other outcomes, were reviewed. A narrative and descriptive synthesis was carried out, as well as several meta-analyses of the differences in risks between Telemedicine and in-person care.The meta-analysis of studies comparing telemedicine care with standard services reveals that the type of care provided does not affect the effectiveness and safety of MAB, nor does it affect user satisfaction, follow-up, or medication adherence.
引用
收藏
页数:23
相关论文
共 71 条
[1]  
Aiken A, 2016, BJOG Internet
[2]   Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study [J].
Aiken, A. R. A. ;
Lohr, P. A. ;
Lord, J. ;
Ghosh, N. ;
Starling, J. .
BJOG-AN INTERNATIONAL JOURNAL OF OBSTETRICS AND GYNAECOLOGY, 2021, 128 (09) :1464-1474
[3]   Safety and effectiveness of self-managed medication abortion provided using online telemedicine in the United States: A population based study [J].
Aiken, Abigail R. A. ;
Romanova, Evdokia P. ;
Morber, Julia R. ;
Gomperts, Rebecca .
LANCET REGIONAL HEALTH-AMERICAS, 2022, 10
[4]   Self reported outcomes and adverse events after medical abortion through online telemedicine: population based study in the Republic of Ireland and Northern Ireland [J].
Aiken, Abigail R. A. ;
Digol, Irena ;
Trussell, James ;
Gomperts, Rebecca .
BMJ-BRITISH MEDICAL JOURNAL, 2017, 357
[5]  
[Anonymous], 2012, SAFE ABORTION: TECHNICAL AND POLICY GUIDANCE FOR HEALTH SYSTEMS
[6]  
[Anonymous], 2014, Prevencion del aborto Inseguro en Colombia: Protocolo para el Sector Salud
[7]  
[Anonymous], 2022, Abortion Care Guideline
[8]  
apps.who, Directrices sobre la atencion para el aborto Resumen ejecutivo
[9]   A randomized comparison of medical abortion and surgical vacuum aspiration at 10-13 weeks gestation [J].
Ashok, PW ;
Kidd, A ;
Flett, GMM ;
Fitzmaurice, A ;
Graham, W ;
Templeton, A .
HUMAN REPRODUCTION, 2002, 17 (01) :92-98
[10]  
Behnamfar F, 2013, PAK J MED SCI, V29, P1367