Satisfaction with and feasibility of no-test telehealth medication abortion vs in-person care with ultrasound in the United States

OBJECTIVES: To compare patients' satisfaction with telehealth medication abortion (MA) and mail-order pharmacy dispensing to in-person care with ultrasound and describe the models' feasibility. STUDY DESIGN: We conducted a prospective, observational study among MA patients ≤ 70 days gestation, aged ≥ 15, from four clinic systems in six U.S. states from 2021 to 2023. Participants completed electronic surveys assessing satisfaction (extremely/very vs somewhat/slightly/not) with three models of MA care (telehealth + mail, telehealth + pick-up, and in-person with ultrasound) and we abstracted chart data from medical records. We conducted multivariable logistic regression to estimate adjusted proportions of satisfaction, and described feasibility including timeliness and condition of receipt of medications, and unwanted abortion disclosure, due to the model of care received. RESULTS: Of 543 patients enrolled, 439 (81%) responded to satisfaction items. A higher adjusted proportion of the telehealth + mail group were extremely/very satisfied with MA overall than the in-person group (94% vs 80%, p < .05), and with level of privacy during the visit (99% vs 82%, p < .05). High adjusted proportions of patients in all groups described being extremely/very satisfied with support (90%-100%) and information (94%-100%) received. Descriptively, almost all (99%) received medications ≤ 70 days gestation, 96% within 3 days, all in good condition, and no participants reported unwanted disclosure of their abortion because someone saw the medications. CONCLUSION: More mail-order telehealth patients reported being extremely/very satisfied with MA than those accessing in-person care. Telehealth models are highly feasible and should be offered to those who need or desire them. IMPLICATIONS: Our findings add to a body of evidence demonstrating high patient satisfaction with and feasibility of telehealth models of MA, underscoring the rationale for expanding access to these models of provision.