Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 151 No. 2930 (2021)

Remote self-assessment follow-up for medical termination of pregnancy at Geneva University Hospitals: an insight into its acceptability, success rate and costs

  • Alessandra Vanetti
  • Rosa Catarino
  • Michal Yaron
DOI
https://doi.org/10.4414/smw.2021.20531
Cite this as:
Swiss Med Wkly. 2021;151:w20531
Published
28.07.2021

Summary

AIMS OF THE STUDY

Remote follow-up based on self-assessment plus a telephone call with a healthcare provider is a safe and reliable method for assessing the success of medical termination of pregnancy (mTOP) and can lead to an important reduction in costs. The aim of the study was to analyse its efficacy, acceptability and associated costs.

METHODS

This was a retrospective comparative study analysing two follow-up protocols for home-based mTOP. A total of 201 women were included: 56 for a standard in-clinic follow-up and 145 for a remote follow-up based on self-assessment with a low-sensitivity urine pregnancy test and a questionnaire. The main outcome was the total number of outpatient consultations needed for each procedure and the associated costs (according to the Swiss tariff system); acceptability and satisfaction were assessed using questionnaires.

RESULTS

Demand for home-based termination increased by 7.8% in the observation period. There was a reduction in diagnosis of retained products of conception, with a consequent decrease of follow-up consultations from 1.47 to 0.41 appointments per patient. A reduction of 38.9% in the average cost per patient (including supplementary follow-up appointments) was observed. Moreover, the remote alternative led to higher patient satisfaction (95.1% vs 55.0%) and acceptability (84.8%). The choice for long-acting reversible contraceptives was not affected by the removal of in-person consultation.

CONCLUSION

A remote follow-up procedure is an acceptable and less costly alternative to hospital-based follow-up with a higher rate of acceptability and adherence by the studied population.

References

  1. World Health Organization. Safe abortion: technical and policy guidance for health systems. 2nd ed. Geneva: WHO; 2012.
  2. Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A. Medical methods for first trimester abortion. Cochrane Database Syst Rev. 2011;11(11):CD002855.
  3. Ngo TD, Park MH, Shakur H, Free C. Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review. Bull World Health Organ. 2011;89(5):360–70. doi:.https://doi.org/10.2471/BLT.10.084046
  4. Fiala C, Winikoff B, Helström L, Hellborg M, Gemzell-Danielsson K. Acceptability of home-use of misoprostol in medical abortion. Contraception. 2004;70(5):387–92. doi:.https://doi.org/10.1016/j.contraception.2004.06.005
  5. Purcell C, Cameron S, Lawton J, Glasier A, Harden J. Self-management of first trimester medical termination of pregnancy: a qualitative study of women’s experiences. BJOG. 2017;124(13):2001–8. doi:.https://doi.org/10.1111/1471-0528.14690
  6. Cameron S, Glasier A, Dewart H, Johnstone A. Women’s experiences of the final stage of early medical abortion at home: results of a pilot survey. J Fam Plann Reprod Health Care. 2010;36(4):213–6. doi:.https://doi.org/10.1783/147118910793048719
  7. Kopp Kallner H, Fiala C, Gemzell-Danielsson K. Assessment of significant factors affecting acceptability of home administration of misoprostol for medical abortion. Contraception. 2012;85(4):394–7. doi:.https://doi.org/10.1016/j.contraception.2011.08.009
  8. World Health Organization. Health worker roles in providing safe abortion care and post-abortion contraception. Geneva: WHO; 2015.
  9. Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD. Self-administered versus provider-administered medical abortion. Cochrane Database Syst Rev. 2020;3(3):CD013181.
  10. National Guideline Alliance (UK). Abortion care. London: National Institute for Health and Care Excellence (UK); 2019 Sep. https://www.nice.org.uk/guidance/ng140.
  11. Baiju N, Acharya G, D’Antonio F, Berg RC. Effectiveness, safety and acceptability of self-assessment of the outcome of first-trimester medical abortion: a systematic review and meta-analysis. BJOG. 2019;126(13):1536–44. doi:.https://doi.org/10.1111/1471-0528.15922
  12. Schmidt-Hansen M, Cameron S, Lohr PA, Hasler E. Follow-up strategies to confirm the success of medical abortion of pregnancies up to 10 weeks’ gestation: a systematic review with meta-analyses. Am J Obstet Gynecol. 2020;222(6):551–563.e13. doi:.https://doi.org/10.1016/j.ajog.2019.11.1244
  13. Clark WH, Gold M, Grossman D, Winikoff B. Can mifepristone medical abortion be simplified? A review of the evidence and questions for future research. Contraception. 2007;75(4):245–50. doi:.https://doi.org/10.1016/j.contraception.2006.11.011
  14. Grossman D, Ellertson C, Grimes DA, Walker D. Routine follow-up visits after first-trimester induced abortion. Obstet Gynecol. 2004;103(4):738–45. doi:.https://doi.org/10.1097/01.AOG.0000115511.14004.19
  15. Fiala C, Cameron S, Bombas T, Parachini M, Agostini A, Lertxundi R, et al. Outcome of first trimester medical termination of pregnancy: definitions and management. Eur J Contracept Reprod Health Care. 2018;23(6):451–7. doi:.https://doi.org/10.1080/13625187.2018.1535058
  16. Haute Autorité de Santé. Contraception chez la femme après une interruption volontaire de grossesse (IVG). Saint-Denis La Plaine: HAS; 2019.
  17. Royal College of Obstetricians and Gynaecologists. Best practice in comprehensive abortion care. Best Practice Paper n.2. London: RCOG; 2015.
  18. Office fédéral de la statistique. Interruption de grossesse. Neuchâtel: OFS; 2019.
  19. Petrou S, Trinder J, Brocklehurst P, Smith L. Economic evaluation of alternative management methods of first-trimester miscarriage based on results from the MIST trial. BJOG. 2006;113(8):879–89. doi:.https://doi.org/10.1111/j.1471-0528.2006.00998.x
  20. Graziosi GC, Bruinse HW, Reuwer PJ, van Kessel PH, Westerweel PE, Mol BW. Misoprostol versus curettage in women with early pregnancy failure: impact on women’s health-related quality of life. A randomized controlled trial. Hum Reprod. 2005;20(8):2340–7. doi:.https://doi.org/10.1093/humrep/dei019
  21. Hu D, Grossman D, Levin C, Blanchard K, Goldie SJ. Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City. BJOG. 2009;116(6):768–79. doi:.https://doi.org/10.1111/j.1471-0528.2009.02142.x
  22. Rausch M, Lorch S, Chung K, Frederick M, Zhang J, Barnhart K. A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss. Fertil Steril. 2012;97(2):355–60.e1. doi:.https://doi.org/10.1016/j.fertnstert.2011.11.044
  23. Sjöström S, Kopp Kallner H, Simeonova E, Madestam A, Gemzell-Danielsson K. Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis. PLoS One. 2016;11(6):e0158645. doi:.https://doi.org/10.1371/journal.pone.0158645
  24. Sjöström S, Dragoman M, Fønhus MS, Ganatra B, Gemzell-Danielsson K. Effectiveness, safety, and acceptability of first-trimester medical termination of pregnancy performed by non-doctor providers: a systematic review. BJOG. 2017;124(13):1928–40. doi:.https://doi.org/10.1111/1471-0528.14712
  25. Kopp Kallner H, Gomperts R, Salomonsson E, Johansson M, Marions L, Gemzell-Danielsson K. The efficacy, safety and acceptability of medical termination of pregnancy provided by standard care by doctors or by nurse-midwives: a randomised controlled equivalence trial. BJOG. 2015;122(4):510–7. doi:.https://doi.org/10.1111/1471-0528.12982
  26. Barnard S, Kim C, Park MH, Ngo TD. Doctors or mid-level providers for abortion. Cochrane Database Syst Rev. 2015;(7):CD011242. doi:.https://doi.org/10.1002/14651858
  27. Fiala C, Safar P, Bygdeman M, Gemzell-Danielsson K. Verifying the effectiveness of medical abortion; ultrasound versus hCG testing. Eur J Obstet Gynecol Reprod Biol. 2003;109(2):190–5. doi:.https://doi.org/10.1016/S0301-2115(03)00012-5
  28. Michie L, Cameron ST. Simplified follow-up after early medical abortion: 12-month experience of a telephone call and self-performed low-sensitivity urine pregnancy test. Contraception. 2014;89(5):440–5. doi:.https://doi.org/10.1016/j.contraception.2014.01.010
  29. Maxwell L, Voetagbe G, Paul M, Mark A. Does the type of abortion provider influence contraceptive uptake after abortion? An analysis of longitudinal data from 64 health facilities in Ghana. BMC Public Health. 2015;15(1):586. doi:.https://doi.org/10.1186/s12889-015-1875-2
  30. Chen MJ, Rounds KM, Creinin MD, Cansino C, Hou MY. Comparing office and telephone follow-up after medical abortion. Contraception. 2016;94(2):122–6. doi:.https://doi.org/10.1016/j.contraception.2016.04.007
  31. Seidenberg A, Fiala C. One stop MToP. Swiss Medical Forum 2015;15(34):745–8. doi:https://doi.org/10.4414/smf.2015.02375

Most read articles by the same author(s)