Self-assessment of medical abortion outcome using symptoms and home pregnancy testing.

OBJECTIVES: We aimed to evaluate compliance with a strategy to enable medical abortion patients to assess treatment outcome on their own and decide whether to seek clinical follow-up. STUDY DESIGN: We enrolled women undergoing medical abortion with mifepristone and misoprostol at three clinics in the United States. Each participant was instructed to perform a multilevel pregnancy test (MLPT) 7 days after mifepristone ingestion and to contact the clinic immediately if the test indicated a possible ongoing pregnancy or if specified symptoms occurred. A telephone call was scheduled 14 days after mifepristone ingestion to evaluate participants who had not contacted the clinic earlier. RESULTS: Of the 343 enrolled participants, 90 (26%) did not provide sufficient follow-up information for analysis of compliance with instructions. Of the 253 (74%) who did, 218 (86%) implemented the self-assessment strategy as instructed, 20 (7.9%) failed to report a non-reassuring MLPT result, 4 (1.6%) failed to promptly report symptoms that the study clinician subsequently judged to require evaluation, and 11 (4.3%) did not perform the MLPT. We ascertained abortion outcomes for 239 (70%) of the enrolled women, of whom three were diagnosed with ongoing pregnancies. One other participant was hospitalized for bleeding. All four women had implemented the strategy correctly. Of the 219 enrolled participants (64%) who provided opinions, 170 (78%) indicated that most could use the MLPT to decide whether they are "OK" after an abortion. We did not ascertain opinions from 124 enrolled participants (36%). CONCLUSIONS: At least two thirds of enrolled participants correctly implemented a strategy using symptom evaluation and a MLPT to assess their own medical abortion outcomes. No ongoing pregnancies occurred in women documented not to have implemented the strategy as intended. Perceived feasibility of the self-assessment approach was high. Implications Statement The common practice of scheduling a clinical contact after every medical abortion may not be necessary to ensure safety; enabling patients to determine for themselves whether or not a contact is needed can be a reasonable approach.

Will insured citizens give up benefit coverage to include the uninsured?

OBJECTIVE: To describe the willingness of insured citizens to trade off their own health benefits to cover the uninsured. DESIGN: Descriptive study of individual and group decisions and decision making using quantitative and qualitative methods. SETTING AND PARTICIPANTS: Twenty-nine groups of citizens (N = 282) residing throughout Minnesota. INTERVENTIONS: Groups participated in Choosing Healthplans All Together (CHAT), a simulation exercise in which participants choose whether and how extensively to cover health services in a hypothetical health plan constrained by limited resources. We describe individual and group decisions, and group dialogue concerning whether to allocate 2% of their premium to cover uninsured children in Minnesota, or 4% of their premium to cover uninsured children and adults. MEASUREMENTS AND MAIN RESULTS: While discussing coverage for the uninsured, groups presented arguments about personal responsibility, community benefit, caring for the vulnerable, social impact, and perceptions of personal risk. All groups chose to insure children; 22 of 29 groups also insured adults. More individuals chose to cover the uninsured at the end of the exercise, after group deliberation, than before (66% vs 54%; P < .001). Individual selections differed from group selections more often for the uninsured category than any other. Nevertheless, 89% of participants were willing to abide by the health plan developed by their group. CONCLUSION: In the context of tradeoffs with their own health insurance benefits, groups of Minnesotans presented value-based arguments about covering the uninsured. All 29 groups and two thirds of individuals chose to contribute a portion of their premium to insure all children and most groups chose also to insure uninsured adults.