Table 1 Indicators used to assess feasibility, effectiveness, safety and client acceptability of a telemedicine medication abortion service delivery model in Musanze, Rwanda
Outcome | Indicator | Interpretation |
|---|---|---|
Feasibility | Providers complete telemedicine consultations for pregnancy termination | 100% telemedicine consultations for pregnancy termination are completed by providers per protocol |
Providers demonstrate ability to dispense misoprostol-mifepristone combination following consultation | 100% providers correctly dispense misoprotol-mifepristone combination per protocol | |
Providers demonstrate ability to successfully provide follow-up care with remote supervision, including treatment of incomplete abortion and post abortion family planning | 100% providers demonstrate ability to successfully provide follow-up care (7th day and 14th day follow-up visits in person or remotely) with remote supervision, including diagnosis and treatment of incomplete abortion and post abortion family planning; less than 5% lost to follow up | |
Training and values clarifications results in provision of high quality for abortion services | 100% trainees attend values clarification sessions and provide high quality services per protocol | |
Supportive supervision adequate to ensure safety of medication abortion | Protocol established support supervision ensures 100% cases of correct drug administration, identification of clinical abnormalities and ectopic pregnancies during ultrasound; correct diagnosis and treatment of side effects as needed | |
Effectiveness | Eligible women successfully complete pregnancy termination at health center through telemedicine services | 95% or higher treatment success rate for pregnancy termination at health centers through telemedicine |
Safety | Appropriate management of side effects by health center provider | 100% cases assessed for side effects and appropriately treated (per protocol) as needed; 100 patients are counselled on expected side effects and take home sanitary pads and pain medication |
Correct counseling and administration of the medication at health center | 100% cases of correct drug use by patients | |
Type and severity of complications; Incomplete cases that need additional interventions | 100% cases correctly diagnosed and treated or referred per protocol, including diagnosis and treatment of continued pregnancies (less than 2%) and treatment of incomplete abortions (less than 5%) | |
Number of referrals | 100% of needed referred cases are done per protocol, including complications that require interventions at hospitals and requested terminations higher than 12 weeks gestation | |
Client Acceptability | Client satisfaction with services (both telemedicine and medication abortion at health center | 90% eligible clients for pregnancy termination accept to be treated at the health center |
Client would recommend services to family and friends | 90% of clients are satisfied with services at health center and would recommend services to family and friends |