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Smith MK, Biderman M, Frotten E, Warden S, Dunn S, Dmytryshyn R, Thorne JG. The Safety and Efficacy of a "No Touch" Abortion Program Implemented in the Greater Toronto Area During the COVID-19 Pandemic. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102429. [PMID: 38458271 DOI: 10.1016/j.jogc.2024.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/10/2024]
Abstract
OBJECTIVES To evaluate the safety and efficacy of first-trimester "No Touch" medication abortion programs at 2 clinics in Toronto, Ontario during their early implementation in response to the COVID-19 pandemic. METHODS This retrospective study included all patients who underwent virtual consultation for mifepristone-misoprostol medication abortion between April 2020-August 2022 at 2 reproductive health clinics. In response to the pandemic, "No Touch" abortion protocols have been developed that align with the Canadian Protocol for the Provision of Medical Abortion via Telemedicine. Records were reviewed for demographic information, clinical course, investigations required, confirmation of complete abortion and adverse events. The primary outcome was complete medication abortion, defined as expulsion of the pregnancy without requiring uterine aspiration. RESULTS A total of 277 patients had abortions initiated in the "No Touch" or "Low Touch" care pathways and had sufficient follow-up to determine outcomes. Of these patients, 92.8% (95% CI 89.7%-95.8%) had a complete medication abortion (n = 257) and 76.1% (n = 159) remained "No Touch" throughout their care. Investigations were performed for 102 participants before or after their abortion, classifying them as "Low Touch". Nineteen patients (6.9%) underwent uterine aspiration. The rate of adverse events was low, with 1 case of a missed ectopic pregnancy and 1 patient requiring hospitalization for endometritis. CONCLUSIONS "No Touch" provision of mifepristone-misoprostol medication abortion care was safe and effective with outcomes comparable to previous studies. These results provide evidence for the efficacy and safety of a "No Touch" approach in the Canadian context, which has the potential to reduce barriers to accessing abortion care.
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Affiliation(s)
- Martha K Smith
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON.
| | - Maya Biderman
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | | | - Sarah Warden
- Bay Centre for Birth Control, Women's College Hospital, Toronto, ON; Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Sheila Dunn
- Bay Centre for Birth Control, Women's College Hospital, Toronto, ON; Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Robert Dmytryshyn
- Bay Centre for Birth Control, Women's College Hospital, Toronto, ON; Department of Family and Community Medicine, University of Toronto, Toronto, ON
| | - Julie G Thorne
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON; Bay Centre for Birth Control, Women's College Hospital, Toronto, ON; Sinai Health Systems, Toronto, ON
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Fu W, McClymont E, Av-Gay G, Dorling M, Atkinson A, Azampanah A, Elwood C, Sauvé L, van Schalkwyk J, Sotindjo T, Money D. Retrospective Cohort Study on the Impact of the COVID-19 Pandemic on Pregnancy Outcomes for Women Living With HIV in British Columbia. J Acquir Immune Defic Syndr 2024; 95:411-416. [PMID: 38489490 DOI: 10.1097/qai.0000000000003384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/18/2023] [Indexed: 03/17/2024]
Abstract
BACKGROUND For pregnant women living with HIV (WLWH), engagement in care is crucial to maternal health and reducing the risk of perinatal transmission. To date, there have been no studies in Canada examining the impact of the COVID-19 pandemic on pregnant WLWH. METHODS This was a retrospective cohort study assessing the impact of the pandemic on perinatal outcomes for pregnant WLWH using data from the Perinatal HIV Surveillance Program in British Columbia, Canada. We compared maternal characteristics, pregnancy outcomes, and clinical indicators related to engagement with care between a prepandemic (January 2017-March 2020) and pandemic cohort (March 2020-December 2022). We investigated preterm birth rates with explanatory variables using logistic regression analysis. RESULTS The prepandemic cohort (n = 87) had a significantly (P < 0.05) lower gestational age at the first antenatal encounter (9.0 vs 11.8) and lower rates of preterm births compared with the pandemic cohort (n = 56; 15% vs 37%). Adjusted odds of preterm birth increased with the presence of substance use in pregnancy (aOR = 10.45, 95% confidence interval: 2.19 to 49.94) in WLWH. There were 2 cases of perinatal transmission of HIV in the pandemic cohort, whereas the prepandemic cohort had none. CONCLUSIONS The pandemic had pronounced effects on pregnant WLWH and their infants in British Columbia including higher rates of preterm birth and higher gestational age at the first antenatal encounter. The nonstatistically significant increase in perinatal transmission rates is of high clinical importance.
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Affiliation(s)
- Winnie Fu
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Elisabeth McClymont
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Gal Av-Gay
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Marisa Dorling
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Andrea Atkinson
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
| | | | - Chelsea Elwood
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Laura Sauvé
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Julie van Schalkwyk
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
| | - Tatiana Sotindjo
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Deborah Money
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada; and
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Tam MW, Davis VH, Ahluwalia M, Lee RS, Ross LE. Impact of COVID-19 on access to and delivery of sexual and reproductive healthcare services in countries with universal healthcare systems: A systematic review. PLoS One 2024; 19:e0294744. [PMID: 38394146 PMCID: PMC10889625 DOI: 10.1371/journal.pone.0294744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/01/2023] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES The COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems. METHODS Following PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596). SYNTHESIS Eighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments. CONCLUSIONS Overall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.
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Affiliation(s)
- Michelle W. Tam
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Victoria H. Davis
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Monish Ahluwalia
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- University of Toronto Faculty of Medicine, 1 King’s College Circle, Toronto, ON, Canada
| | - Rachel S. Lee
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
| | - Lori E. Ross
- University of Toronto Dalla Lana School of Public Health, Toronto, ON, Canada
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4
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Malek M, Homer CS, McDonald C, Hannon CM, Moore P, Wilson AN. Abortion care at 20 weeks and over in Victoria: a thematic analysis of healthcare providers' experiences. BMC Pregnancy Childbirth 2024; 24:112. [PMID: 38321392 PMCID: PMC10845525 DOI: 10.1186/s12884-024-06299-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 01/28/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND In many countries, abortions at 20 weeks and over for indications other than fetal or maternal medicine are difficult to access due to legal restrictions and limited availability of services. The Abortion and Contraception Service at the Royal Women's Hospital in Victoria, Australia is the only service in the state that provides this service. The views and experiences of these abortion providers can give insight into the experiences of staff and women and the abortion system accessibility. The aim of this study was to examine health providers' perceptions and experiences of providing abortion care at 20 weeks and over for indications other than fetal or maternal medicine, as well as enablers and barriers to this care and how quality of care could be improved in one hospital in Victoria, Australia. METHODS A qualitative study was conducted at the Abortion and Contraception Service at the Royal Women's Hospital. Participants were recruited by convenience and purposive sampling. Semi-structured interviews were conducted one-on-one with participants either online or in-person. A reflexive thematic analysis was performed. RESULTS In total, 17 healthcare providers from medicine, nursing, midwifery, social work and Aboriginal clinical health backgrounds participated in the study. Ultimately, three themes were identified: 'Being committed to quality care: taking a holistic approach', 'Surmounting challenges: being an abortion provider is difficult', and 'Meeting external roadblocks: deficiencies in the wider healthcare system'. Participants felt well-supported by their team to provide person-centred and holistic care, while facing the emotional and ethical challenges of their role. The limited abortion workforce capacity in the wider healthcare system was perceived to compromise equitable access to care. CONCLUSIONS Providers of abortion at 20 weeks and over for non-medicalised indications encounter systemic enablers and barriers to delivering care at personal, service delivery and healthcare levels. There is an urgent need for supportive policies and frameworks to strengthen and support the abortion provider workforce and expand provision of affordable, acceptable and accessible abortions at 20 weeks and over in Victoria and in Australia more broadly.
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Affiliation(s)
- Mary Malek
- Monash University, Wellington Rd, Clayton, VIC, 3800, Australia
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia
| | | | - Clare McDonald
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Catherine M Hannon
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Paddy Moore
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia
| | - Alyce N Wilson
- Burnet Institute, 85 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Royal Women's Hospital, 20 Flemington Rd, Parkville, VIC, 3052, Australia.
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Guilbert E, Bois G. Évaluation de l'information transmise sur l'avortement médicamenteux dans les cliniques d'avortement du Québec en 2021 - Partie 2. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:125-133. [PMID: 36567050 DOI: 10.1016/j.jogc.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Communication of information is a key component of quality family planning services. It allows for an informed choice between surgical and medication abortion. METHODS Québec abortion clinics were contacted by 2 mystery client clinical profiles (PC) between October 8 and November 17, 2021. Data collection was done simultaneously by a data collector. The unit of analysis was the PC. Descriptive analyses and statistical tests were performed, as well as a qualitative analysis of the collected comments. RESULTS Of the 17 information topics deemed necessary for an informed choice, 35% were obtained spontaneously. These included what tests to perform (78%), professionals to meet before the procedure (77%), gestational age limit (64%), side effects (49%) (especially alarming ones), and the number of visits required (42%). On a score of 12, the average information quality score was 7.2 (standard deviation [SD] 2.7). A score of less than 7/12 was obtained by 41% of PCs. A high information quality score was associated with a perceived friendlier attitude of the person responding to the call, and the unprompted transmission of more information. For 51/78 PCs, abortifacient medications were served at the clinic, and for 13 of them, the first medication had to be taken in front of the physician. CONCLUSION The information received when calling Québec abortion clinics for an appointment for abortion was often insufficient and made it difficult to make an informed choice between the 2 methods of abortion. This may explain the low proportion of medication abortion in Québec.
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Affiliation(s)
- Edith Guilbert
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, QC.
| | - Geneviève Bois
- Département de médecine familiale et de médecine d'urgence, Université de Montréal, Montréal, QC
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6
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Guilbert E, Bois G. Évaluation de l'accès à l'avortement médicamenteux dans les cliniques d'avortement du Québec en 2021 - Partie I. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:116-124. [PMID: 36567051 DOI: 10.1016/j.jogc.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In 2020, 11.9% of abortions in Quebec were medication abortions, compared with 32.4% in Ontario. The objective of this evaluation was to assess the quality of access to medication abortion in Quebec abortion clinics, where 91% of these abortions are performed. METHODS Quebec abortion clinics were contacted by 2 mystery client clinical profiles between October 8 and November 17, 2021. Descriptive analyses and statistical tests were performed, as well as a qualitative analysis of collected comments. RESULTS Medication abortion up to 63 days of gestational age or less was available in 39/47 abortion clinics, more in rural and remote areas than in urban or suburban areas (P = 0.013). The mean time from first call to first appointment was 6.2 calendar days (standard deviation [SD] 4.0), shorter in rural and remote areas (P = 0.005) and in clinics affiliated with a hospital or local community service center (P = 0.010). The mean number of visits required for medication abortion was higher than for surgical abortion (2.9 [SD] 0.9 vs. 2.3 [SD] 1.1) (P < 0.001). For one in three clinical profiles (26/78, 33%), a telemedicine visit was possible. Medication abortion entirely accessible through telemedicine was not available. Unfavorable comments about medication abortion were frequent. CONCLUSION Access to medication abortion is difficult in Quebec and access through telemedicine is almost non existent. Restrictions imposed by the Collège des médecins du Québec (CMQ) and constraints imposed on patients limit access.
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Affiliation(s)
- Edith Guilbert
- Département d'obstétrique, gynécologie et reproduction, Université Laval, Québec, Québec, Canada.
| | - Geneviève Bois
- Département de médecine familiale et de médecine d'urgence, Université de Montréal, Montréal, Québec, Canada
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Zusman EZ, Munro S, Norman WV, Soon JA. Pharmacist direct dispensing of mifepristone for medication abortion in Canada: a survey of community pharmacists. BMJ Open 2022; 12:e063370. [PMID: 36207038 PMCID: PMC9557265 DOI: 10.1136/bmjopen-2022-063370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Pharmacists were acknowledged as the most appropriate healthcare professional to dispense mifepristone for medication abortion shortly after the prescription therapy became available in January 2017 in Canada. OBJECTIVE We aimed to identify the facilitators and barriers for successful initiation and ongoing dispensing of mifepristone among community pharmacists across Canada. STUDY DESIGN We surveyed community pharmacists from urban/rural practice settings across Canada by recruiting from January 2017 to January 2019 through pharmacist organisations, professional networks, at mifepristone training courses and at professional conferences. The Diffusion of Innovations theory informed the study design, thematic analysis and interpretation of findings. We summarised categorical data using counts and proportions, χ2 tests, Wilcoxon rank-sum and proportional odds logistic regression. RESULTS Of the 433 responses from dispensing community pharmacists across 10/13 Canadian provinces and territories, 93.1% indicated they were willing and ready to dispense mifepristone. Key facilitators were access to a private consultation setting (91.4%), the motivation to increase accessibility for patients (87.5%) and to reduce pressure on the healthcare system (75.3%). The cost of the mifepristone/misoprostol product was an initial barrier, subsequently resolved by universal government subsidy. A few pharmacists mentioned liability, lack of prescribers or inadequate stock as barriers. CONCLUSIONS Pharmacist respondents from across Canada reported being able and willing to dispense mifepristone and rarely mentioned barriers to stocking/dispensing the medication in the community pharmacy setting. The removal of initial regulatory obstacles to directly dispense mifepristone to patients facilitated the provision of medication abortion in the primary care setting.
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Affiliation(s)
- Enav Z Zusman
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Providence Health Care, Vancouver, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Public Health, Environments and Society, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Judith A Soon
- Collaboration for Outcomes Research and Evaluation, The University of British Columbia Faculty of Pharmaceutical Sciences, Vancouver, British Columbia, Canada
- Department of Family Practice, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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Renner RM, Ennis M, Kyeremeh A, Norman WV, Dunn S, Pymar H, Guilbert E. Telemedicine for First-Trimester Medical Abortion in Canada: Results of a 2019 Survey. Telemed J E Health 2022; 29:686-695. [PMID: 36126299 PMCID: PMC10171945 DOI: 10.1089/tmj.2022.0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine has the potential to improve abortion access disparities in Canada. We aimed to explore the provision of telemedicine for first-trimester medical abortion and related barriers in 2019. Methods: We conducted a national, cross-sectional, anonymized, web-based survey of clinicians who provided abortion care in 2019 in Canada. We distributed our survey through professional health organizations to maximize identification of possible eligible respondents and used a modified Dillman technique to foster responses. Questions elicited provider demographics, clinical characteristics, including telemedicine first-trimester medical abortion and perceived related barriers. Descriptive statistics were analyzed using R software. Results: Among 465 respondents, 388 reported providing first-trimester medical abortion across Canada; 44.0% reported experience using telemedicine for some components of care: 49.3% of primary care clinicians and 28.7% of specialists. Telemedicine was used for initial consultation (86.0%), prescription (82.2%), or follow-up (92.2%). The median percentage of telemedicine providers' patients who underwent a dating ultrasound was 90.0. The majority usually followed up with patients through quantitative human chorionic gonadotropin (hCG) (84.2%). Seventy-eight percent perceived barriers to telemedicine; the most common being inability to confirm gestational age with ultrasound (43.0%), and lack of provincial telemedicine abortion fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Discussion: In 2019, fewer than half of respondents reported providing some aspects of first-trimester medical abortion through telemedicine and the majority perceived barriers. Our results can inform knowledge translation activities to reduce barriers and increase telemedicine abortion care in Canada.
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Affiliation(s)
- Regina M Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.,Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada
| | - Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.,Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada
| | - Ama Kyeremeh
- Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada
| | - Wendy V Norman
- Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada.,Department of Family Practice, University of British Columbia, Vancouver, Canada.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sheila Dunn
- Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada.,Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | - Helen Pymar
- Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada.,Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Manitoba, Canada
| | - Edith Guilbert
- Contraception and Abortion Research Team, Women's Health Research Institute, British Columbia Women's Hospital and Health Centre, Vancouver, Canada.,Department of Obstetrics, Gynecology and Reproduction, Université Laval, Québec City, Canada
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Ennis M, Renner R, Guilbert E, Norman WV, Pymar H, Kean L, Carson A, Martin-Misener R, Dunn S. Provision of First-trimester Medication Abortion in 2019: Results from the Canadian Abortion Provider Survey. Contraception 2022; 113:19-25. [PMID: 35351448 DOI: 10.1016/j.contraception.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the Canadian first-trimester medication abortion (MA) workforce and their clinical care following the introduction of mifepristone in 2017, updated national clinical practice guidelines and government approval of nurse practitioners (NPs) as first-trimester MA providers. STUDY DESIGN We conducted a national, self-administered, cross-sectional survey of abortion providers in 2019. Our bilingual (French/English) survey collected information on demographics, abortion number, and clinical care characteristics. The true number of abortion providers is unknown thus we cannot calculate a survey response rate. To maximize identification of possibly eligible respondents, we widely distributed the survey between July and December 2020 through health professional organizations, using a modified Dillman technique. We used descriptive statistics to characterize the workforce and clinical practices. RESULTS Four-hundred-sixty-five clinicians responded, of whom 388 provided first-trimester MA. Physicians (n=358) and NPs (n=30) reported providing 13,429 first-trimester MAs in 2019 which represented 27.7% of all reported abortions in the survey. The majority of first-trimester MA respondents were primary care physicians (n=245, 63.1%), had less than five years' experience (n=223, 61.3%) and practiced outside of hospitals (n=228, 66.5%). Forty-three percent (n=165) practiced rurally, and 44.0% (n=136) used telemedicine for some abortion care. Ninety-nine percent (n=350) used a guideline-recommended mifepristone/misoprostol regimen while 14.5% (n=51) sometimes used methotrexate. Patients most commonly received mifepristone/misoprostol at community pharmacies (median 100.0%; interquartile range 50.0-100.0%). CONCLUSION Our results suggest that there are many new first-trimester MA providers, an increase in the proportion of MAs since 2012 and a shift to primary care settings. Respondents widely adopted mifepristone. IMPLICATIONS STATEMENT Our results highlight that, following mifepristone introduction, many new primary care practitioners started providing first-trimester medication abortion throughout Canada, including the first non-physicians. This increased access to abortion particularly in rural and underserved communities. These results could inform future directions in policy, guidelines, and abortion access initiatives.
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Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | - Edith Guilbert
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Obstetrics, Gynecology and Reproduction, Laval University, Quebec City, Quebec, Canada
| | - Wendy V Norman
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Family Practice, University of British Columbia, Vancouver, BC, Canada; Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Pymar
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lauren Kean
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Carson
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ruth Martin-Misener
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheila Dunn
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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