Effectiveness and Safety of Medication Abortion by Advanced Practice Clinicians [ID 3926]

INTRODUCTION: Many guidelines support medication abortion (MAB) provision by advanced practice clinicians (APCs) (nurse practitioners, certified nurse midwives, and physician assistants). Although it is widely accepted that APCs are qualified to provide abortion care, most existing data focuses on the effectiveness and safety of APCs providing procedural rather than MAB. We aimed to assess the effectiveness and safety of MABs provided by APCs. METHODS: We compared the proportion of patients who experienced a complete abortion (without an unplanned repeat dose of misoprostol/mifepristone or aspiration) after receiving an MAB provided by an APC (including counseling, prescription, and dispensing) to MABs provided by physicians and to published complete abortion rates. We also assessed rates of emergency department visits and severe adverse events. We included all MABs provided at Planned Parenthood of the Pacific Southwest in San Diego, Imperial, and Riverside Counties from November 2021 to December 2024. RESULTS: Among 26,905 MABs with follow-up data, the complete abortion rate was 93.3% (95% CI, 93.0–93.6%); 93.0% (95% CI, 93.0–93.6%) among 26,747 MABs provided by APCs, and 90.8% (95% CI, 85.6–96.1%) among 120 provided by physicians; these rates did not differ by clinician type ( P =.28). Abortions provided by APCs were noninferior compared to published estimates of 93.3% (z-test of equivalence P <.001). Among those with follow-up, rates of emergency department visits (0.3%) and serious adverse events (0.1%) were equivalent between clinician groups. CONCLUSIONS/IMPLICATIONS: Rates of additional misoprostol/mifepristone or aspiration after MAB and adverse events were low and equivalent across all groups. MABs are safe and effective when provided by APCs.