title: Changes in service delivery patterns after introduction of telemedicine provision of medical abortion in Iowa.
abstract: OBJECTIVE
  We assessed the effect of a telemedicine model providing medical abortion on service delivery in a clinic system in Iowa.
  
  
  METHODS
  We reviewed Iowa vital statistic data and billing data from the clinic system for all abortion encounters during the 2 years prior to and after the introduction of telemedicine in June 2008 (n = 17,956 encounters). We calculated the distance from the patient's residential zip code to the clinic and to the closest clinic providing surgical abortion.
  
  
  RESULTS
  The abortion rate decreased in Iowa after telemedicine introduction, and the proportion of abortions in the clinics that were medical increased from 46% to 54%. After telemedicine was introduced, and with adjustment for other factors, clinic patients had increased odds of obtaining both medical abortion and abortion before 13 weeks' gestation. Although distance traveled to the clinic decreased only slightly, women living farther than 50 miles from the nearest clinic offering surgical abortion were more likely to obtain an abortion after telemedicine introduction.
  
  
  CONCLUSIONS
  Telemedicine could improve access to medical abortion, especially for women living in remote areas, and reduce second-trimester abortion.
authors.affiliation: Ibis Reproductive Health, Oakland, CA 94612, USA. DGrossman@ibisreproductivehealth.org
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Grossman
authors.forename: Kate
authors.initials: K
authors.lastname: Grindlay
authors.forename: Todd
authors.initials: T
authors.lastname: Buchacker
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Potter
authors.forename: Carl P
authors.initials: CP
authors.lastname: Schmertmann
mesh_terms: D000029:Abortion, Legal / Q000706:statistics & numerical data* / Q000639:trends; D000293:Adolescent; D000328:Adult; D002648:Child; D003695:Delivery of Health Care / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa; D008499:Medical Records; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D011247:Pregnancy; D017216:Telemedicine / Q000331:legislation & jurisprudence*; D014195:Travel / Q000706:statistics & numerical data; D014837:Voluntary Health Agencies; D055815:Young Adult