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期刊来源：Nat Med

原文链接：https://doi.org/10.1038/s41591-024-02834-w

摘要内容如下：

在堕胎仍然合法但其有效性和安全性的证据有限的州，远程健康堕胎已成为解决需求激增的关键。California Home Aboration by TeleHealth（CHAT）是一项前瞻性研究，跟踪了2021年4月至2022年1月期间在20个州和华盛顿特区运营的三家虚拟诊所通过远程医疗进行药物流产的孕妇。使用标准化的无测试协议对个人进行筛选，主要依靠他们的病史来评估医疗资格。我们评估了有效性，定义为200mg米非司酮和1600μg米索前列醇（或更低）在没有额外干预的情况下完全流产；安全性通过无严重不良事件来衡量。我们使用多变量逻辑回归和多重插补来估计比率，以说明缺失数据。在6，034例流产中，97.7%（95%可信区间（CI）=97.2-98.1%）在初始治疗后无后续已知干预或继续妊娠的情况下完成流产。总体而言，99.8%（99.6-99.9%）的流产后未发生严重不良事件。总体而言，0.25%的患者经历了严重的流产相关不良事件，0.16%的患者接受了异位妊娠治疗，1.3%的患者在流产后接受了急诊治疗。同步和异步护理模式之间的有效性或安全性没有差异。远程医疗药物流产是有效的、安全的，并且与公布的亲自药物流产护理率相当。

英文原文如下：

Abstracts

Telehealth abortion has become critical to addressing surges in demand in states where abortion remains legal but evidence on its effectiveness and safety is limited. California Home Abortion by Telehealth (CHAT) is a prospective study that follows pregnant people who obtained medication abortion via telehealth from three virtual clinics operating in 20 states and Washington, DC between April 2021 and January 2022. Individuals were screened using a standardized no-test protocol, primarily relying on their medical history to assess medical eligibility. We assessed effectiveness, defined as complete abortion after 200 mg mifepristone and 1,600 μg misoprostol (or lower) without additional intervention; safety was measured by the absence of serious adverse events. We estimated rates using multivariable logistic regression and multiple imputation to account for missing data. Among 6,034 abortions, 97.7% (95% confidence interval (CI) = 97.2-98.1%) were complete without subsequent known intervention or ongoing pregnancy after the initial treatment. Overall, 99.8% (99.6-99.9%) of abortions were not followed by serious adverse events. In total, 0.25% of patients experienced a serious abortion-related adverse event, 0.16% were treated for an ectopic pregnancy and 1.3% abortions were followed by emergency department visits. There were no differences in effectiveness or safety between synchronous and asynchronous models of care. Telehealth medication abortion is effective, safe and comparable to published rates of in-person medication abortion care.

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