To assess the estimated effectiveness and safety of medication abortions (MABs) provided by advanced practice clinicians (APCs) compared to those provided by physicians, hypothesizing that MABs provided by APCs are similarly effective and safe.
Approach:
Study Design: Retrospective noninferiority cohort study of MABs provided at Planned Parenthood of the Pacific Southwest from December 2021 to December 2025.
Participants: Included all MABs less than 77 days’ gestation, with a total of 59,150 MABs analyzed.
Data Collection: Ultrasonography confirmed pregnancy dating, and follow-up assessments were conducted to check for continuing pregnancy or retained products.
Statistical Analysis: Multilevel multivariable logistic regression was used to compare effectiveness and adverse events between clinician types.
Key Findings:
Estimated effectiveness of MABs was 92.9% overall (95% CI, 92.6% to 93.1%), 92.9% for APCs (95% CI, 92.6% to 93.2%), and 90.1% for physicians (95% CI, 87.1% to 93.0%).
The difference in effectiveness between APCs and physicians was -2.8% (95% CI, -5.7% to 0.1%), indicating noninferiority.
Adverse events were low, with 0.2% of MABs resulting in emergency department visits and 0.1% reporting adverse events.
Interpretation:
MAB effectiveness provided by APCs is noninferior to that provided by physicians.
Limitations:
Unbalanced group sizes and loss to follow-up may impact the generalizability of the findings.
The study lacked power to detect the prespecified 2% noninferiority margin.
Conclusion:
The study demonstrates that MABs provided by APCs are noninferior in effectiveness to those provided by physicians.
