Posting is not the same as dispensing.

If you are going to use reduced waiting times to substantiate your preference for telemedicine abortion, then you need to make sure that you are comparing like-for-like. It is wrong to compare the elapsed time from first contact to in-clinic dispensing, with the time from first contact to posting the abortion pills; posting is not the same as dispensing.

“New study shows early medical abortions at home provide a safe, effective & more accessible service for women… the time a woman had to wait to have an abortion after a consultation was reduced by nearly four days.”

This was the announcement made by The Royal College of Obstetricians and Gynaecologists in February, referring to the cohort study authored by Aiken et al., published here by the BJOG.

The authors open up the Discussion section of their report saying: “… Clinical outcomes with telemedicine are equivalent to in-person care and access to abortion care is better, with both waiting times and gestational age at the time of abortion significantly reduced.”

The data presented show the mean waiting time to treatment declined from 10.7 days in the traditional pathway to 6.5 days in the telemedicine-hybrid cohort. (hence the four days reduction announced by RCOG).

It’s a shame that the authors chose to make this claim and to use it to support their conclusion that telemedicine is better, brings advantages, and is not inferior to clinic-based abortion care because it’s not a reliable claim and thus begs the reader to question other claims.

In the study, waiting time was defined as the interval from first contact with the abortion provider to when medication was dispensed (either in-person in clinic or posted); 10.7 days up to the time of dispensing compared with 6.5 days up to the time of posting. But no accounting for the time for the posted medication to arrive at the patient’s home or the time between that and when the woman self-administered the medication, which might not have been the same day as receipt of the treatment package.

In our mystery client investigation, the average time from the final call with the abortion provider until the abortion pills arrived at the home of our volunteer was 2.4 days. There were a number of cases in which it took as many as 5 days for the packs to be received, especially if over a weekend. In 8% of our cases, the pills-by-post never arrived, the package was lost in the post; one of the service providers said when we reported this, “once we sent the package it’s out of our control.”

When an abortion provider is consulting with a woman by telemedicine, they cannot know for certain at the time of posting the pills, how long it will be before the woman will receive the treatment pack or if she will be the one for whom the package is lost, never mind how long she might delay between the receipt of the abortion pills and her self-administration of these.

When we account for the time taken in the post and a minimum of time for the woman to get herself ready to take the first tablet, we might find that the time from first contact with the abortion provider to administration of the first tablet is more or less the same regardless of where and how the consultations take place.

You cannot claim that telemedicine leads to a reduction in waiting time, that’s just poor data-science.

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