What do primary care providers need in a prescriber checklist for mifepristone medication abortion?

Conference: 
SAPC ASM 2020 - cancelled due to pandemic
Talk Code: 
Z.7
Presenter: 
Wendy V. Norman
Twitter: 
@wvnorman, @cartgrac
Co-authors: 
Sarah Munro, Kate Wahl, Sheila Dunn, Edith Guilbert.
Author institutions: 
University of British Columbia, London School of Hygiene & Tropical Medicine, University of Toronto, Laval University.

Problem

Primary care providers are challenged to bridge the gap between medical abortion guidelines and a comprehensive approach to prescribing and follow up within a primary care visit. We aimed to develop and implement a charting checklist and quick reference guide to support the adoption of medication abortion among Canadian primary care providers.

Approach

The preliminary checklist and reference guide were adapted from 7 clinical exemplars using the 2016 Society of Obstetricians & Gynecologists of Canada guidelines on medical abortion. Materials were subjected to expert review (n=6). Front-line providers (n=5) gave feedback on the revised materials in ‘think-aloud’ interviews and rated the materials using the System Usability Scale (SUS). Final materials were approved by expert reviewers; English and French versions were shared with providers through communities of practice convened online and in person.

Findings

Expert reviewers were 4 clinician-researchers, 1 community stakeholder, and 1 knowledge translation scientist. Front-line participants were 2 family physicians, 1 obstetrician-gynecologist, 1 family medicine resident, and 1 registered nurse. Front-line participants had between 2 and 20+ years in practice; 3 had previous experience with medication abortion and 2 did not. Changes to the materials focused on alignment with clinical guidelines and best practices as well as suitability for the clinical context. The median SUS was 86.25 (69.4-97.5), indicating good-to-excellent usability. Between April 2018 and October 2019, the checklist was downloaded or distributed 1423 times (1354 English, 69 French) and the reference guide was downloaded 912 times (841 English, 71 French).

Consequences

Primary health care providers are starting to add medication abortion to their scope of practice for the first time, particularly in Canada where this innovation has been recently approved. The tools described above have been optimized to support the implementation of medical abortion services in the primary care context.

Submitted by: 
Wendy V. Norman
Funding acknowledgement: 
The authors have no competing interests to declare. This study was supported by a Canadian Institutes of Health Research Partnership for Health System Improvement Grant (PHE148161), in partnership with the Michael Smith Foundation for Health Research (16743), and by a research grant from the Society of Family Planning (SFPRF11-19). SM was supported as a Trainee and a Scholar of the Michael Smith Foundation for Health Research (16603, 18270). WVN was supported as a Scholar of the Michael Smith Foundation for Health Research (2012-5139 (HSR)), and as an Applied Public Health Research Chair by the Canadian Institutes of Health Research (CPP-329455-107837). In kind support was contributed by the Women’s Health Research Institute of British Columbia Women’s Hospital and Health Centre of the Provincial Health Services Authority of British Columbia. Planned Parenthood Ottawa supported this project in many ways including contributions of staff time, recruiting and coordination.