Medical Abortion

Increasing access by telemedicine

The way of the future

Paul Hyland MB BS FRCS FRCOG FRANZCOG

The Tabbot Foundation

Launched 28th September 2015

‘The problem with the Australian practice of abortion is

that an objectively grave matter has been reduced to a

question of the mother’s convenience.’ – Tony Abbott

www.theage.com.au

The Tabbot Process

Make Contact

Freecall 1800 180 880

Screening Questions

Arrange investigations

The Tabbot Process

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Initial Tests

FBC

βhCG level

Blood Group

Ultrasound

The Tabbot Process

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Initial Tests

Medical Consultation

Psychologist Structured Interview

Queensland

New South Wales

Australian Capital Territory

Northern Territory

Abortion can be lawfully performed where it is necessary to prevent serious danger to the woman’s

life or physical or mental health

In Queensland, social and economic considerations cannot be taken into account

(R v Bayliss and Cullen (1986)

In Queensland and NSW:

In the Northern Territory:

Abortion can be lawfully performed if “the termination is considered appropriate having regard

to the woman's current and future physical, psychological and social circumstances”

The Tabbot Process

Make Contact

Initial Tests

Medical Consultation

Telephone

Gynaecologist

Review the results

Ensure the safety

Explain the procedure

Assess analgesia

The Tabbot Process

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Initial Tests

Medical Consultation

Psychologist Interview

Medications Express Mailed

Ondansetron 8mg wafers (4)

Mifepristone 200 mg tablet (1)

Misoprostol 200 µg tablets (4)

Azithromycin 500mg tablets (3)

Analgesic medications

• Paracetamol

• Codeine

• Ibuprofen

• Tramadol

Misoprostol 200 µg tablets (10)

Medications Supplied

The Detail

8am Anti-emetic

8:30am Azithromycin Analgesics

9am Misoprostol 800 mcg

2pm Repeat Misoprostol 400mcg

5pm Nurse Call

The Tabbot Process

Make Contact

Initial Tests

Medical Consultation

Psychologist Interview

Medications Express Mailed

Support by Registered Nurse

The Tabbot Process

Make Contact

Initial Tests

Medical Consultation

Psychologist Interview

Medications Express Mailed

Support by Registered Nurse

Confirmation of Termination

Second βhCG

80% fall by 7 days

Australia wide Medical Abortion Cost

$250.00

Remoteness Australia Tabbot

RA 1 70.9% 45.2%

RA 2 18.1% 40.5%

RA 3 8.8% 12.4%

RA 4 1.4% 1.3%

RA 5 0.9% 0.5%

Complete abortion 96.9%

Surgical 3.1%

o RPOC 2.0%

o Missed Abortion 0.6%

o Failed abortion 0.2%

Outcome

If medical abortion works — so

why aren't more doctors using it?

1 Administrative barriers

o Group practice partners not agreeable

o Adapting to general practice

o Unfamiliar procedure infrequently provided

o Medico-legal fears

o After Hours care

o Providing adequate follow up

o Fears of protests

1 Administrative barriers

2 Legal barriers

o Australian Capital Territory

o South Australia

1 Administrative barriers

2 Legal barriers

3 Lack of information on availability, both public and professional

Local legal requirements

The restrictions below are for ads targeting this country: Australia

• abortion-inducing drugs

Advertisements

‘any statement, pictorial representation or design, however made, that is intended,

whether directly or indirectly, to promote the use or supply of the goods.’

The Act makes it a criminal offence to advertise prescription-only medicines

Prohibited representations

Section 42DL(1)(a) of the Act, together with section 5(1) of the Code, prohibits advertisements that

“contain.. a representation specified in Part 1 of Appendix 6” of the Code.

The prohibited representations specified in Part 1 of Appendix 6 of the Code include “any

representation regarding abortifacient action” such as

“…abortion pill”

“…a drug that induces uterine contractions “

1. Administrative barriers

2. Legal barriers

3. Lack of information on availability, both public and professional

4. A reluctance to change from a well-established surgical service with

a high success rate and a low complication rate

Surgical Medical

Brisbane $500.00 $580.00

Cairns $375.00

Canberra $500.00 $550.00

Darwin $550.00

Hobart $500.00

Melbourne $495.00 $560.00

Perth $795.00 $550.00

Rockhampton $500.00 $580.00

Sydney $410.00 $490.00

Townsville $715.00 $790.00

Dr Marie Telehealth $352.70

Cairns Doctors $325.00

Tabbot Foundation $250.00

Acceptability

• Bleeding – need additional misoprostol

• Pain – inadequate analgesia

o Paracetamol

o Codeine

o Ibuprofen

o Tramadol