Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study.
abortion
family planning
health policy
health services accessibility
implementation
interview
qualitative research
Journal
Annals of family medicine
ISSN: 1544-1717
Titre abrégé: Ann Fam Med
Pays: United States
ID NLM: 101167762
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
30
08
2019
revised:
21
01
2020
accepted:
11
02
2020
entrez:
15
9
2020
pubmed:
16
9
2020
medline:
9
7
2021
Statut:
ppublish
Résumé
Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada. We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice. Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.
Identifiants
pubmed: 32928757
pii: 18/5/413
doi: 10.1370/afm.2562
pmc: PMC7489974
doi:
Substances chimiques
Mifepristone
320T6RNW1F
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
413-421Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2020 Annals of Family Medicine, Inc.
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