Uptake of long-acting reversible contraception after telemedicine delivered abortion during Covid-19

Abstract

Background

During COVID-19, early medical abortion (EMA) at home in Scotland was largely delivered by telemedicine. Short-acting post-abortion contraception was provided with EMA medications, but long-acting reversible contraception (LARC) (implant, injectable and intrauterine device) required an in-person visit. We wished to assess LARC uptake following telemedicine abortion, and factors associated with method receipt.

Methods

A prospective observational cohort study of patients accessing abortion via NHS Lothian (October 2020 to February 2021). Patients were offered contraception at telemedicine consultation and their choice was recorded in their clinical notes. Those wishing LARC were directed to the service’s rapid-access LARC clinic. We reviewed electronic patient records six weeks post-abortion to determine whether patients received their chosen method.

Results

944 patients had an abortion; 768 (81.4%) had EMA, 131 (13.9%) had a medical or surgical abortion in hospital. The most popular contraceptive method was the progestogen-only pill (n = 324, 34%). 330 patients (35%) requested LARC but less than half (153/330; 46%) received this. Of patients choosing LARC, those who attended the clinic for a pre-abortion ultrasound, or had an abortion in hospital, were more likely to initiate LARC than those having full telemedicine EMA. Nulliparity, gestation over 7 weeks, and age under-26 years were also positively associated with initiating LARC.

Conclusion

During COVID-19 there was demand for post-abortion LARC but less than half of patients received this by six weeks. Provision was enhanced when in-person clinical interactions took place. Interventions are required to facilitate timely access and initiation of LARC with telemedicine delivered abortion care.

摘要

背景：在COVID-19期间, 苏格兰家庭早期药物流产( EMA )主要通过远程医疗进行。短效流产后避孕药和EMA药物一起提供给患者, 但长效可逆避孕( LARC ) ( 植入、注射和宫内节育器 )需患者亲自就诊。我们旨在评估远程药物流产后LARC的实施情况, 以及与采用LARC相关的因素。

方法：选择在2020年10月至2021年2月期间, 通过英国国家医疗服务体系（NHS）洛锡安区实施流产的患者进行一项前瞻性观察性队列研究。在远程医疗咨询中为患者提供避孕措施, 并将患者的选择记录在他们的临床笔记中。指引那些希望LARC的人快速访问LARC诊所。我们审查了患者在流产后6周的电子记录, 以确定患者是否接受了他们选择的方法。

结果：944例流产患者中, 768例(81.4%)进行EMA, 131例(13.9%) 在医院进行药物或手术流产。最常用的避孕方法是单纯孕激素药物(n=324,34%)。330例患者(35%)要求LARC但不足一半患者(153/330; 46%)进行了LARC。在选择LARC的患者中, 在诊所做流产前超声检查或在医院流产的患者比那些完全远程医疗EMA的患者更容易实施LARC。未产妇、孕7周以上、年龄小于26岁与LARC的实施也呈正相关。

结论：在COVID-19期间, 患者对流产后LARC有需求, 但不到一半的患者在六周后进行了LARC。而在进行面对面的临床互动时, 更容易进行LARC。我们需要采取干预措施, 以便通过远程医疗流产的患者及时访问和进行LARC。

Keywords:

• Contraception
• abortion
• telemedicine
• LARC

Acknowledgements

We wish to thank the Chalmers Centre clinical research nurses, clinical coding team and nursing and midwifery staff of the Choices Clinic for collecting, entering, and cleaning data for the clinical database.

Author contributions

STC conceived the idea for the study. JRW and AD further developed the protocol and data extraction tool. AD collected the data and conducted primary analysis. JRW and STC assisted with further data analysis. All authors contributed to the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are not publicly available, reasonable requests will be considered by the authors.

Additional information

Funding

This work was conducted by staff working at the MRC Centre for Reproductive Health, which is supported by grant: MR/N022556/1.