PDF(Pubmed)
Abstract：
UNASSIGNED: Before 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.
UNASSIGNED: To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.
UNASSIGNED: This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days\' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023.
UNASSIGNED: Mifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.
UNASSIGNED: Proportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.
UNASSIGNED: Clinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing.
UNASSIGNED: The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.
UNASSIGNED: To estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.
UNASSIGNED: This prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days\' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023.
UNASSIGNED: Mifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.
UNASSIGNED: Proportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.
UNASSIGNED: Clinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing.
UNASSIGNED: The findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.
摘要：
■在2021年之前，美国食品和药物管理局要求米非司酮亲自分发，限制药物流产。
■为了估计效果，可接受性,以及使用邮购药房分配米非司酮用于药物流产的可行性。
■这项前瞻性队列研究于2020年1月至2022年5月进行，包括7个州的11个诊所（5个堕胎诊所和6个初级保健场所，其中4个是堕胎规定的新内容）。符合条件的参与者在妊娠63天或更短时间寻求药物流产，说英语或西班牙语，年龄在15岁或以上，并愿意口服米索前列醇。在通过面对面筛查评估药物流产的资格后，米非司酮和米索前列醇使用邮购药房处方。患者在诊所接受了标准的随访护理。从医疗记录中收集临床信息。同意的参与者在注册后3天和14天完成了关于他们经历的在线调查。共纳入540名参与者；10名退出或未服药。数据从2022年8月到2023年12月进行了分析。
■米非司酮,200毫克，和米索前列醇,800微克,开处方给邮购药房，邮寄给参与者，而不是亲自分发。
■仅使用药物完全流产的患者比例，报告对药物流产的满意度，并及时报告药物的交付。
■在506名参与者中获得并分析了510例流产（96.2％）的临床结果信息（中位[IQR]年龄，27[23-31]年；506[100%]女性；194[38.3%]黑人，88[17.4%]西班牙裔，141[27.9%]白色，和45[8.9%]多种族/其他个人)。其中,436名参与者(85.5%;95%CI,82.2%-88.4%)在3天内接受药物治疗。499例（97.8％；95％CI，96.2％-98.9％）在药物使用后发生完全流产。有24例不良事件（4.7％）因药物流产症状而寻求护理；3例患者（0.6％；95％CI，0.1％-1.7％）经历了需要住院治疗的严重不良事件（1例输血）；然而，没有与邮购配药相关的不良事件.在477名参与者中，431（90.4％；95％CI，87.3％-92.9％）表示他们将再次使用邮购配药进行堕胎护理，435名参与者(91.2%;95%CI,88.3%-93.6%)报告对药物流产的满意度.研究结果与其他已发表的关于亲自分配药物流产的研究结果相似。
这项队列研究的结果表明，邮购药房配药米非司酮用于药物流产是有效的，患者可以接受，可行,严重不良事件的患病率较低。应扩大这种护理模式，以改善获得药物流产服务的机会。
■为了估计效果，可接受性,以及使用邮购药房分配米非司酮用于药物流产的可行性。
■这项前瞻性队列研究于2020年1月至2022年5月进行，包括7个州的11个诊所（5个堕胎诊所和6个初级保健场所，其中4个是堕胎规定的新内容）。符合条件的参与者在妊娠63天或更短时间寻求药物流产，说英语或西班牙语，年龄在15岁或以上，并愿意口服米索前列醇。在通过面对面筛查评估药物流产的资格后，米非司酮和米索前列醇使用邮购药房处方。患者在诊所接受了标准的随访护理。从医疗记录中收集临床信息。同意的参与者在注册后3天和14天完成了关于他们经历的在线调查。共纳入540名参与者；10名退出或未服药。数据从2022年8月到2023年12月进行了分析。
■米非司酮,200毫克，和米索前列醇,800微克,开处方给邮购药房，邮寄给参与者，而不是亲自分发。
■仅使用药物完全流产的患者比例，报告对药物流产的满意度，并及时报告药物的交付。
■在506名参与者中获得并分析了510例流产（96.2％）的临床结果信息（中位[IQR]年龄，27[23-31]年；506[100%]女性；194[38.3%]黑人，88[17.4%]西班牙裔，141[27.9%]白色，和45[8.9%]多种族/其他个人)。其中,436名参与者(85.5%;95%CI,82.2%-88.4%)在3天内接受药物治疗。499例（97.8％；95％CI，96.2％-98.9％）在药物使用后发生完全流产。有24例不良事件（4.7％）因药物流产症状而寻求护理；3例患者（0.6％；95％CI，0.1％-1.7％）经历了需要住院治疗的严重不良事件（1例输血）；然而，没有与邮购配药相关的不良事件.在477名参与者中，431（90.4％；95％CI，87.3％-92.9％）表示他们将再次使用邮购配药进行堕胎护理，435名参与者(91.2%;95%CI,88.3%-93.6%)报告对药物流产的满意度.研究结果与其他已发表的关于亲自分配药物流产的研究结果相似。
这项队列研究的结果表明，邮购药房配药米非司酮用于药物流产是有效的，患者可以接受，可行,严重不良事件的患病率较低。应扩大这种护理模式，以改善获得药物流产服务的机会。
