title: Comparison of remote and in-clinic follow-up after methotrexate/misoprostol abortion.
abstract: OBJECTIVE
  This study compared adherence to follow-up and clinical outcomes between standard in-clinic and remote follow-up after methotrexate/misoprostol abortion.
  
  
  METHODS
  This nonrandomized trial recruited women requesting medical abortion at two sexual health clinics in Toronto, Canada. Women received methotrexate 50 mg/m(2) followed 3-7 days later by 800 mcg of misoprostol self-administered vaginally. For Day 15, follow-up participants could choose standard in-clinic follow-up with ultrasound and assessment or remote telephone follow-up with serum β-hCG performed at a community laboratory and symptom checklist. Standard and remote follow-up groups were compared for adherence, defined as completing follow-up within 7 days of the scheduled time, and clinical outcomes. Characteristics associated with adherence were assessed using multivariable logistic regression.
  
  
  RESULTS
  Of 129 women, 86 (67%) chose remote follow-up. Nonadherence rates for remote (28%) and standard (23%) follow-up groups did not differ in univariate (p=.57) or multivariable analysis (odds ratio: 1.09, 95% confidence interval: 0.39-3.01). Rates of emergency/hospital visits were 3% and 9% for remote and standard groups, respectively (p=.22), and complete loss to follow was 6% and 14% in remote and standard groups (p=.18). Nonadherent women were more likely to be undecided about their contraception (65% vs. 28%; p=.002), and this difference persisted in the multivariable analysis.
  
  
  CONCLUSIONS
  Given a choice of remote or in-clinic follow-up after methotrexate/misoprostol abortion, most women chose remote follow-up. Rates of adherence to follow-up, adverse outcomes and complete loss to follow-up were similar for women choosing remote and standard follow-up.
  
  
  CONCLUSIONS
  Since standard and remote follow-up after methotrexate/misoprostol abortion are associated with similar adherence to follow-up and similar safety profiles, women should be offered their choice of follow-up method.
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada; Women's College Research Institute, Toronto, ON, Canada. Electronic address: sheila.dunn@wchospital.ca.
authors.forename: Sheila
authors.initials: S
authors.lastname: Dunn
authors.affiliation: Women's College Research Institute, Toronto, ON, Canada. Electronic address: dilzayn.panjwani@wchospital.ca.
authors.forename: Dilzayn
authors.initials: D
authors.lastname: Panjwani
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: melini.gupta@mail.utoronto.ca.
authors.forename: Melini
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: christopher.meaney@utoronto.ca.
authors.forename: Christopher
authors.initials: C
authors.lastname: Meaney
authors.affiliation: Choice in Health Clinic, Toronto, ON, Canada. Electronic address: rebecca.morgan.ec@gmail.com.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Morgan
authors.affiliation: Women's College Hospital, Toronto, ON, Canada; Choice in Health Clinic, Toronto, ON, Canada. Electronic address: erika.feuerstein@wchospital.ca.
authors.forename: Erika
authors.initials: E
authors.lastname: Feuerstein
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000328:Adult; D000554:Ambulatory Care Facilities; D002170:Canada; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008727:Methotrexate / Q000008:administration & dosage*; D016595:Misoprostol / Q000008:administration & dosage*; D015999:Multivariate Analysis; D065228:Non-Randomized Controlled Trials as Topic; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D017216:Telemedicine
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D008727:Methotrexate
keywords: Medical abortion; Methotrexate; Remote follow-up; Telephone follow-up