Integrating mifepristone into primary care in Canada's capital: A multi-methods exploration of the Medical Abortion Access Project

Contraception ◽  
2022 ◽  
Author(s):  
Kathryn J. LaRoche ◽  
Ariane Wylie ◽  
Mira Persaud ◽  
Angel M. Foster
Keyword(s):  
Primary Care ◽  
Medical Abortion ◽  
Abortion Access ◽  
Access Project

Primary care providers’ knowledge, attitudes and practices of medical abortion: a systematic review

2019 ◽  
pp. bmjsrh-2019-200487 ◽  
Author(s):  
Asvini K Subasinghe ◽  
Seema Deb ◽  
Danielle Mazza
Keyword(s):  
Primary Care ◽  
Nursing Students ◽  
Primary Healthcare ◽  
Small Proportion ◽  
Medical Abortion ◽  
Primary Care Providers ◽  
Criminal Prosecution ◽  
Care Providers ◽  
Attitudes And Practices ◽  
Knowledge Attitudes And Practices

BackgroundDespite the availability of medical abortifacients, and their potential use in primary care, only a small proportion of primary healthcare professionals provide medical abortion services. Understanding the perspectives of primary care providers on delivering medical abortion is pertinent to identifying barriers to medical abortion service provision and increasing access for women globally.ObjectiveTo understand the knowledge, attitudes and practices of primary healthcare providers regarding medical abortion services.DesignFour databases (Medline, EMBASE, Web of Science (WOS) and Scopus) were searched using search terms related to medical abortion and primary care. The Joanna Briggs Institute Critical Appraisal tools were used to appraise the methodological quality of studies included.ResultsSome 22 studies were identified, conducted across 15 countries, comprising 6072 participants. Study participants comprised doctors and residents (n=8), nurses and nursing students (n=5), and pharmacists (n=3) and six studies were conducted with mixed samples of providers. Medical abortion was deemed acceptable by some doctors, but fear of criminal prosecution, in countries where abortion is still restrictive, left doctors and nurses circumspect about providing medical abortion. Pharmacists referred women to other providers with only a small proportion dispensing medical abortifacients. General practitioners, nurses and trainees had mixed knowledge of medical abortion and emphasised the need for training on delivery of medical abortion and dissemination of guidelines. Conversely, pharmacists reported poor knowledge regarding medical abortion regimens and complications.ConclusionsIncreased dissemination of training and resources is pertinent to supporting primary care providers delivering medical abortion services and to increasing access for women on a global scale.

Towards safe abortion access: an exploratory study of medical abortion in Cambodia

2014 ◽  
Vol 22 (sup44) ◽  
pp. 47-55 ◽  
Author(s):  
Pascale Hancart Petitet ◽  
Leakhena Ith ◽  
Melissa Cockroft ◽  
Thérèse Delvaux
Keyword(s):  
Exploratory Study ◽  
Medical Abortion ◽  
Safe Abortion ◽  
Abortion Access

scholarly journals From Feminist Anarchy to Decolonisation: Understanding Abortion Health Activism Before and After the Repeal of the 8th Amendment

2020 ◽  
Vol 124 (1) ◽  
pp. 69-85 ◽  
Author(s):  
Deirdre Niamh Duffy
Keyword(s):  
Direct Action ◽  
Medical Abortion ◽  
Feminist Activism ◽  
Health Activism ◽  
Abortion Law ◽  
Political Discourses ◽  
Irish Context ◽  
Before And After ◽  
Abortion Access ◽  
The Republic

This article analyses abortion health activism (AHA) in the Irish context. AHA is a form of activism focused on enabling abortion access where it is restricted. Historically, AHA has involved facilitating the movement of abortion seekers along ‘abortion trails’ (Rossiter, 2009). Organisations operate transnationally, enabling access to abortion care across borders. Such AHA is a form of feminist anarchism, resisting prohibitions on abortion through direct action. However, AHA work has changed over time. Existing scholarship relates this to advancements in medical technology, particularly the emergence of telemedicine and the increased use of early medical abortion. This article goes beyond those explanations to explore how else AHA has changed by comparing the work of AHA before and after the Republic of Ireland’s referendum on abortion in May 2018. Based on this, I argue that there is a visible shift in the politics of AHA. Drawing on qualitative data from research on AHA organisations along the Liverpool–Ireland Abortion Corridor, specifically those based outside Ireland, the article argues that in the aftermath of the referendum, Irish AHA has increasingly moved towards decolonising feminist activism, thus drawing attention to the relationship between abortion health activists (AHAs) and broader political discourses entangled with abortion law reform.

scholarly journals Nurses are Key Members of the Abortion Care Team: Why aren’t Schools of Nursing Teaching Abortion Care?

2019 ◽  
Vol 1 (2) ◽  
pp. 17-29
Author(s):  
Martha Paynter ◽  
Wendy V. Norman ◽  
Ruth Martin-Misener
Keyword(s):  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Social Stigma ◽  
Medical Abortion ◽  
World Health ◽  
Safe Procedure ◽  
Abortion Care ◽  
Schools Of Nursing ◽  
Abortion Access ◽  
Education Support

Abortion is a common and safe procedure in Canada, with the Canadian Institute for Health Information reporting approximately 100,000 procedures per year. Yet access remains problematic. As abortion is unrestricted by criminal law in Canada, access is limited by geographic barriers and by a shortage of providers. We present a feminist critical lens to describe how the marginalization of nursing and nurses in abortion care contributes to social stigma and public misunderstanding about abortion access. The roles of registered nurses and nurse practitioners in abortion advocacy, service navigation, counselling, education, support, physiological care and follow up are underutilized and under-researched. In 2015, decades after its availability elsewhere in the world, Health Canada approved mifepristone (a pill for medical abortion). In 2017, provincial regulators began to authorize nurse practitioners to independently provide medical abortion care, as appropriate given the inclusion in nurse practitioner scope of practice to order diagnostic tests, make diagnoses, and treat health conditions. Ensuring nurse practitioners are able to practice medical abortion has the potential to significantly increase abortion access for rural, remote and other marginalized populations. There is also an opportunity to optimize the registered nurse role in abortion care. However, achieving these improvements is challenging as abortion is not routinely taught in Canadian Schools of Nursing. We argue that to destigmatize abortion and improve access, undergraduate nursing and nurse practitioner programs across the country must begin to include abortion and family planning competencies.

scholarly journals Early medical abortion services provided in Australian primary care

2021 ◽  
Author(s):  
Asvini K Subasinghe ◽  
Kevin McGeechan ◽  
Jessica E Moulton ◽  
Luke E Grzeskowiak ◽  
Danielle Mazza
Keyword(s):  
Primary Care ◽  
Medical Abortion

scholarly journals Audit of a Services to Improve Access project to improve access for skin cancer surgery

2016 ◽  
Vol 8 (3) ◽  
pp. 267
Author(s):  
A. S. D. Mayne
Keyword(s):  
Primary Care ◽  
Skin Cancer ◽  
Cost Savings ◽  
Cancer Surgery ◽  
Substantial Cost ◽  
Surgical Services ◽  
General Practices ◽  
Skin Cancer Surgery ◽  
Access Project ◽  
Improve Access

ABSTRACT Like many general practices in low decile communities with a high percentage of elderly patients, the Paeroa Medical Centre was relying heavily on secondary care to provide skin cancer surgical services, which led to delays in treatment and under-utilisation of the skills available in primary care. A new system utilising Services to Improve Access (SIA) funding was developed to provide partially funded skin cancer surgery within primary care. A 6-month period of this work by one general practitioner (GP) was audited. This has demonstrated that the majority of minor dermatological surgery can be successfully managed in primary care, with more timely and convenient treatment and substantial cost savings to the health system.

scholarly journals Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Courtney Devane ◽  
Regina M. Renner ◽  
Sarah Munro ◽  
Édith Guilbert ◽  
Sheila Dunn ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Diffusion Of Innovations ◽  
Scale Up ◽  
Medical Abortion ◽  
First Trimester ◽  
Validated Questionnaire ◽  
Barriers To Implementation ◽  
Facilitators And Barriers ◽  
The Impact

Abstract Background Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. Methods In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh’s conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin’s framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré’s validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. Results We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada. Conclusions Our team operationalized Greenhalgh’s theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision.

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