1
|
Lee SC, Norman WV. Emergency contraception subsidy in Canada: a comparative policy analysis. BMC Health Serv Res 2022; 22:1110. [PMID: 36050668 PMCID: PMC9438154 DOI: 10.1186/s12913-022-08416-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, cost prohibits access to emergency contraception (EC) which may assist to prevent unintended pregnancy. The drug, ulipristal acetate (UPA-EC), is more clinically effective and cost-effective than the prior standard levonorgestrel (LNG-EC). We analyzed provincial EC subsidization policies and examined underlying decision-making processes. METHODS We undertook documentary analysis of provincial EC subsidization policies in publicly available drug formularies. We conducted semi-structured interviews with key informants to explore the processes underlying current policies. RESULTS Quebec is the only province to subsidize UPA-EC, whilst all ten provinces subsidize LNG-EC. As such, provincial EC subsidization policies do not align with the latest UPA-EC evidence. Interviews revealed that evidence was valued in the policymaking process and formulary decisions were made through interdisciplinary consensus. CONCLUSIONS We identify a gap between EC subsidization policies and the latest evidence. Institutional structures affect policies reflecting evolving evidence. Increasing interdisciplinary mechanisms may encourage evidence-based policies.
Collapse
Affiliation(s)
- Sabrina C Lee
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, WN5002-665 William Ave, Winnipeg, MB, R3E 0L8, Canada
| | - Wendy V Norman
- Faculty of Public Health & Policy, London School of Hygiene & Tropical, London, UK. .,Department of Family Practice, University of British Columbia, 320-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| |
Collapse
|
2
|
Devane C, Renner RM, Munro S, Guilbert É, Dunn S, Wagner MS, Norman WV. Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers. Pilot Feasibility Stud 2019; 5:126. [PMID: 31720004 PMCID: PMC6839244 DOI: 10.1186/s40814-019-0520-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/17/2019] [Indexed: 11/25/2022] Open
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.
Collapse
Affiliation(s)
- Courtney Devane
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- School of Nursing, University of British Columbia, Vancouver, BC Canada
| | - Regina M. Renner
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Sarah Munro
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Édith Guilbert
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Institut national de santé publique du Québec, Quebec City, QC Canada
| | - Sheila Dunn
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Marie-Soleil Wagner
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, University of Montreal, CHU Sainte-Justine, Montreal, QC Canada
| | - Wendy V. Norman
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Family Practice, Women’s Health Research Institute, University of British Columbia, E202-4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| |
Collapse
|
3
|
Hadorn F, Comte P, Foucault E, Morin D, Hugli O. Task-shifting Using a Pain Management Protocol in an Emergency Care Service: Nurses' Perception through the Eye of the Rogers's Diffusion of Innovation Theory. Pain Manag Nurs 2015; 17:80-7. [PMID: 26602151 DOI: 10.1016/j.pmn.2015.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 08/13/2015] [Accepted: 08/20/2015] [Indexed: 01/09/2023]
Abstract
It has been shown that over 70% of patients waiting in emergency departments (EDs) do not receive analgesics, despite the fact that more than 78% complain of pain. A clinical innovation in the form of a pain management protocol that includes task-shifting has been implemented in the ED of a university hospital in Switzerland in order to improve pain-related outcomes in patients. This innovation involves a change in clinical practice for physicians and nurses. The aim of this study is to explore nurses' perceptions on how well this innovation is adopted. This descriptive correlational study took place in the ED of a Swiss university hospital; the hospital provides healthcare for the city, the canton, and adjoining cantons. A convenience sample of 37 ED nurses participated. They were asked to complete a questionnaire comprising 56 statements based on Rogers's "Diffusion of Innovation" theory. Nurses' opinions (on a 1-10 Likert scale) indicate that the new protocol benefits the ED (mean [M] = 7.4, standard deviation [SD] = 1.21), is compatible with nursing roles (M = 8.0, SD = 1.9), is not too complicated to apply (M = 2.7, SD = 1.7), provides observable positive effects in patients (M = 7.0, SD = 1.28), and is relatively easy to introduce into daily practice (M = 6.5, SD = 1.0). Further studies are now needed to examine patients' experiences of this innovation.
Collapse
Affiliation(s)
- Fabienne Hadorn
- Department of Medicine, Vaud University Hospital, Lausanne, Switzerland.
| | - Pascal Comte
- University of Applied Sciences and Arts - Western Switzerland, ARC University of Applied Sciences, Switzerland
| | - Eliane Foucault
- Emergency Services, Vaud University Hospital, Lausanne, Switzerland
| | - Diane Morin
- Emergency Services, Vaud University Hospital, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Olivier Hugli
- Emergency Services, Vaud University Hospital, Lausanne, Switzerland; Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
4
|
Norman WV, Soon JA, Panagiotoglou D, Albert A, Zed PJ. The acceptability of contraception task-sharing among pharmacists in Canada--the ACT-Pharm study. Contraception 2015; 92:55-61. [PMID: 25818593 DOI: 10.1016/j.contraception.2015.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 02/16/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Access to prescription contraception is often limited by the availability of physicians, particularly in rural areas. Pharmacists are available but are not authorized in Canada to prescribe contraceptives, an innovation proved successful in the United States. It is unknown whether Canadian pharmacists, particularly those in rural areas, are willing to adopt this innovation and what barriers and facilitators they predict. We explored the acceptability and feasibility for independent provision of contraception at pharmacies throughout British Columbia (BC). METHODS This mixed-methods study used validated questionnaires followed by optional structured interviews among all rural, and a sample of urban, community pharmacies in BC. Analyses use descriptive, logistic regression and qualitative thematic evaluation. RESULTS Responding community pharmacies represent all geographic health regions of BC and the range of pharmacy business models. Respondents reported a mean of 17 years in practice. Seventy percent of pharmacies reported a private counseling area. Over 80%, including pharmacies in all regions, indicated willingness to prescribe hormonal contraceptives. Factors associated with willingness to prescribe were comfort using a protocol to assess sexual history, confidence about staff availability and public acceptability, and fewer years in practice. Pharmacists requested training in assessment protocols and liability issues prior to implementation. INTERPRETATION Pharmacies from all areas throughout BC, responded and report a high degree of acceptability and feasibility for independent prescription of hormonal contraceptives. As pharmacists are often the most accessible health professional in rural areas, pharmacist provision of hormonal contraceptives has potential to improve access to contraception.
Collapse
Affiliation(s)
- Wendy V Norman
- Contraception Access Research Team-Groupe de recherche sur l'accessibilité à la contraception (CART/GRAC), Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia (BC), Canada; Department of Family Practice, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
| | - Judith A Soon
- Contraception Access Research Team-Groupe de recherche sur l'accessibilité à la contraception (CART/GRAC), Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia (BC), Canada; Department of Family Practice, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada; Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada
| | - Dimitra Panagiotoglou
- Contraception Access Research Team-Groupe de recherche sur l'accessibilité à la contraception (CART/GRAC), Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia (BC), Canada; School of Population and Public Health, Faculty of Medicine, UBC, Vancouver, BC, Canada
| | - Arianne Albert
- Contraception Access Research Team-Groupe de recherche sur l'accessibilité à la contraception (CART/GRAC), Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia (BC), Canada
| | - Peter J Zed
- Contraception Access Research Team-Groupe de recherche sur l'accessibilité à la contraception (CART/GRAC), Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, British Columbia (BC), Canada; Faculty of Pharmaceutical Sciences, UBC, Vancouver, BC, Canada; Department of Emergency Medicine, Faculty of Medicine, UBC, Vancouver, BC, Canada
| |
Collapse
|
5
|
Development of a Survey to Assess the Acceptability of an Innovative Contraception Practice among Rural Pharmacists. PHARMACY 2014. [DOI: 10.3390/pharmacy2010124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|