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Rowlands S, Harrison-Woolrych M. Improving access to medicines for early medical abortion: learning from experiences of medicines licensing and service delivery. BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:234-237. [PMID: 37640520 DOI: 10.1136/bmjsrh-2023-201949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Sam Rowlands
- Department of Medical Science & Public Health, Bournemouth University, Poole, UK
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Zusman EZ, Munro S, Norman WV, Soon JA. Dispensing mifepristone for medical abortion in Canada: Pharmacists' experiences of the first year. Can Pharm J (Ott) 2023; 156:204-214. [PMID: 37435503 PMCID: PMC10331362 DOI: 10.1177/17151635231176270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 07/13/2023]
Abstract
Background Mifepristone for medical abortion was first dispensed by community pharmacists in Canada directly to patients in January 2017. We asked about pharmacists' experiences over their first year dispensing mifepristone in order to evaluate the frequency of the new practice and assess availability in urban/rural pharmacies. Methods From August to December 2019, we invited 433 community pharmacists who had completed a baseline survey at least 1 year prior to participate in a follow-up online survey. We summarized categorical data using counts and proportions and conducted a qualitative thematic analysis of open-ended responses. Results Among 122 participants, 67.2% had dispensed the product, and 48.4% routinely stocked mifepristone. Pharmacists reported a mean of 26 and median of 3 (interquartile range, 1, 8) mifepristone prescriptions filled in their pharmacies in the previous year. Participants perceived that the benefits of making mifepristone available in pharmacies included increased abortion access for patients (n = 115; 94.3%), reduced pressure on the health care system (n = 104; 85.3%), increased rural and remote abortion access (n = 103; 84.4%) and increased interprofessional collaborations (n = 48; 39.3%). Few participants reported challenges to maintaining adequate stock of mifepristone, but these challenges included low demand (n = 24; 19.7%), short expiry dating (n = 12; 9.8%) and drug shortages (n = 8; 6.6%). The overwhelming majority, 96.7%, reported that their communities did not resist the provision of mifepristone by their pharmacy. Interpretation Participating pharmacists reported many benefits and very few barriers to stocking and dispensing mifepristone. Both urban and rural communities responded positively to enhanced access to mifepristone in their community. Conclusions Mifepristone is well accepted by pharmacists within the primary care system in Canada.
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Affiliation(s)
- Enav Z. Zusman
- Contraception and Abortion Research Team of the Women’s Health Research Institute, UBC, and of the Collaboration for Outcomes Research and Evaluation
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research, Vancouver, British Columbia
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver
| | - Judith A. Soon
- Contraception and Abortion Research Team of the Women’s Health Research Institute, UBC, and of the Collaboration for Outcomes Research and Evaluation
- Department of Family Practice, University of British Columbia, Vancouver
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Carson A, Stirling-Cameron E, Paynter M, Munro S, Norman WV, Kilpatrick K, Begun S, Martin-Misener R. Barriers and enablers to nurse practitioner implementation of medication abortion in Canada: A qualitative study. PLoS One 2023; 18:e0280757. [PMID: 36701296 PMCID: PMC9879445 DOI: 10.1371/journal.pone.0280757] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020-2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners.
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Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Munro SB, Dunn S, Guilbert ER, Norman WV. Advancing Reproductive Health through Policy-Engaged Research in Abortion Care. Semin Reprod Med 2022; 40:268-276. [PMID: 36746159 DOI: 10.1055/s-0042-1760213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mifepristone medication abortion was first approved in China and France more than 30 years ago and is now used in more than 60 countries worldwide. It is a highly safe and effective method that has the potential to increase population access to abortion in early pregnancy, closer to home. In both Canada and the United States, the initial regulations for distribution, prescribing, and dispensing of mifepristone were highly restricted. However, in Canada, where mifepristone was made available in 2017, most restrictions on the medication were removed in the first year of its availability. The Canadian regulation of mifepristone as a normal prescription makes access possible in community primary care through a physician or nurse practitioner prescription, which any pharmacist can dispense. In this approach, people decide when and where to take their medication. We explore how policy-maker-engaged research advanced reproductive health policy and facilitated this rapid change in Canada. We discuss the implications of these policy advances for self-management of abortion and demonstrate how in Canada patients "self-manage" components of the abortion process within a supportive health care system.
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Affiliation(s)
- Sarah B Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Edith R Guilbert
- Department of Obstetrics, Gynecology and Reproduction, Laval University, Québec City, Québec, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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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, Contandriopoulos D, Guilbert E, Dunn S, Kaczorowski J, Darling EK, Albert A, Styffe C, Norman WV. Abortion services and providers in Canada in 2019: results of a national survey. CMAJ Open 2022; 10:E856-E864. [PMID: 36167421 PMCID: PMC9578753 DOI: 10.9778/cmajo.20210232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Since 2016, abortion care has undergone several important changes, particularly related to the provision of medical abortion using mifepristone. We aimed to document characteristics of the abortion care workforce in Canada after the update of clinical practice guidelines of mifepristone use for medical abortion. METHODS We conducted a national, web-based, anonymized, bilingual (English/French) survey. We collected demographics and clinical care characteristics of physicians and nurse practitioners who provided abortion care in 2019. Between July and December 2020, we distributed the survey through professional organizations, including The College of Family Physicians of Canada and The Society of Obstetricians and Gynaecologists of Canada. We present descriptive statistics. RESULTS Overall, 465 respondents representing all 10 provinces and 3 territories in Canada completed the survey. Of these, 388 (83.4%), including 30 nurse practitioners, provided first-trimester medical abortion, of which 350 (99.4%) used mifepristone. Two hundred and nineteen (47.1%) respondents provided first-trimester surgical abortion, 109 (23.4%) provided second-trimester surgical abortion and 115 (24.7%) provided second- or third-trimester medical abortion. Half of respondents reported fewer than 5 years of experience with any abortion care. Respondents reported providing a total of 48 509 abortions in 2019, including 32 345 (66.7%) first-trimester surgical abortions and 13 429 (27.7%) first-trimester medical abortions. In Quebec, only 1918 (12.5%) of reported abortions were first-trimester medical abortions. Primary care providers provided 34 540 (71.2%) of the total abortions. First-trimester medical abortions represented 44.4% (n = 2334) of all abortions in rural areas, as opposed to 25.6% (n = 11 067) in urban areas. INTERPRETATION The increased availability of medical abortion facilitates abortion access, especially in primary care and rural settings, and where surgical abortion is not available. Rejuvenation of the workforce is a critical contributor to equitable access to abortion services.
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Affiliation(s)
- Regina M Renner
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Madeleine Ennis
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Damien Contandriopoulos
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Sheila Dunn
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Janusz Kaczorowski
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth K Darling
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Arianne Albert
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Claire Styffe
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
| | - Wendy V Norman
- Department of Obstetrics and Gynaecology (Renner, Ennis), University of British Columbia, Vancouver, BC; Contraception and Abortion Research Team (Renner, Ennis, Contandriopoulos, Guilbert, Dunn, Kaczorowski, Darling, Albert, Styffe, Norman), Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC; School of Nursing (Contandriopoulos), University of Victoria, Victoria, BC; Department of Obstetrics Gynecology and Reproduction (Guilbert), Laval University, Québec City, Que.; Department of Family & Community Medicine (Dunn), University of Toronto, Toronto, Ont.; Women's College Research Institute (Dunn), Women's College Hospital, Toronto, Ont.; Department of Family and Emergency Medicine (Kaczorowski), Université de Montréal, Montréal, Que.; Department of Obstetrics & Gynecology (Darling), McMaster University, Hamilton, Ont.; School of Population and Public Health (Styffe) and Department of Family Practice (Norman), University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy (Norman), London School of Hygiene & Tropical Medicine, London, UK
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Kaller S, Ma M, Gurazada T, Baba CF, Rafie S, Raine-Bennett T, Averbach S, Chen M, Berry E, Meckstroth KR, Grossman D. "No Big Deal": A Qualitative Study of Pharmacists' Perspectives on Dispensing Mifepristone for Medication Abortion. Womens Health Issues 2022; 32:571-577. [PMID: 35918240 DOI: 10.1016/j.whi.2022.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Until December 2021, the United States Food and Drug Administration impeded abortion access by restricting pharmacists from dispensing mifepristone, one of two drugs used in medication abortion. This study aimed to explore pharmacists' perspectives on dispensing mifepristone. METHODS We conducted semistructured interviews with pharmacists before and after participating in a pilot project where mifepristone was dispensed from their pharmacies. We thematically coded all interview transcripts, then summarized emergent themes related to pharmacists' support, comfort, experiences, and concerns around dispensing mifepristone. RESULTS Between May 2018 and July 2020, we interviewed 29 pharmacists (22 at baseline and 15 at follow-up, with 8 completing both interviews) from 5 pharmacies. At both baseline and follow-up, interviewees strongly supported pharmacists dispensing mifepristone, feeling it would improve quality of care by providing more convenient medication abortion access and streamlined service delivery and take advantage of pharmacists' expertise and availability. All pharmacists interviewed at follow-up reported dispensing mifepristone except two who were willing but did not have the opportunity. Pharmacists experienced few challenges dispensing mifepristone. Their main concern was perceived discomfort that other pharmacists and pharmacy staff may experience, particularly in conservative areas or small pharmacies where pharmacists' refusal to dispense mifepristone could impede abortion access. CONCLUSIONS Most pharmacists supported dispensing mifepristone and were comfortable doing so after education on mifepristone and medication abortion. They dispensed mifepristone without difficulty, in a similar process as dispensing other medications. With the recent removal of U.S. Food and Drug Administration restrictions prohibiting it, our findings support the feasibility of pharmacists dispensing mifepristone.
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Affiliation(s)
- Shelly Kaller
- Advancing New Standards in Reproductive Health (ANISRH), University of California, Oakland, California.
| | - Melanie Ma
- Department of Obstetrics and Gynecology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California
| | - Tanvi Gurazada
- Advancing New Standards in Reproductive Health (ANISRH), University of California, Oakland, California
| | - C Finley Baba
- Advancing New Standards in Reproductive Health (ANISRH), University of California, Oakland, California
| | - Sally Rafie
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego Health, San Diego, California
| | - Tina Raine-Bennett
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, California
| | - Melissa Chen
- Department of Obstetrics and Gynecology, University of California, Sacramento, California
| | - Erin Berry
- Planned Parenthood Great Northwest, Hawai'i, Alaska, Indiana, Kentucky, Seattle, Washington
| | - Karen R Meckstroth
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, California
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANISRH), University of California, Oakland, California
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8
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LaRoche KJ, Wylie A, Persaud M, Foster AM. Integrating mifepristone into primary care in Canada's capital: A multi-methods exploration of the Medical Abortion Access Project. Contraception 2022; 109:37-42. [PMID: 35031301 DOI: 10.1016/j.contraception.2022.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Following the 2017 introduction of mifepristone in Canada and both ensuing regulatory changes and increased demand for medication abortion care, Planned Parenthood Ottawa created the Medical Abortion Access Project (MAAP). This study aimed to document outcomes, identify facilitators and barriers, and distill learnings from an initiative that sought to recruit and support primary care clinicians in providing mifepristone/misoprostol in Canada's capital. METHODS We employed a multi-methods evaluation strategy that included reviewing MAAP-related documents, evaluating the project log, and conducting in-depth interviews with clinicians at five sites. In the final analytic phase, we integrated the findings from the different evaluation components. RESULTS From May 2017 through July 2018, the MAAP helped 14 primary care facilities in Ottawa become medication abortion providers; nine began providing mifepristone/misoprostol to existing patients and five began offering mifepristone/misoprostol to the public. The program recruited four new pharmacies to stock the combination package and trained two sonography clinics in abortion-related protocols. Program participants identified patient demand as a key driver of medication abortion provision but required information and logistical support from the MAAP to operationalize service delivery. New abortion providers reflected positively on the community of practice that the MAAP created, which enabled them to offer and receive technical and emotional support from colleagues across the city. CONCLUSIONS A number of primary care clinicians in Ottawa were able to successfully integrate medication abortion care into their practices with MAAP support. Future research should explore whether this type of community-based intervention can be replicated in other settings. IMPLICATIONS Evidence-based regulation of mifepristone by health authorities is a critical step to increasing access to medication abortion care. However, deregulation alone was insufficient to integrate medication abortion services into primary care in Ottawa. Community-based programs like the MAAP can help providers make sense of shifting regulations and practice guidelines, overcome logistical barriers, and ultimately increase access to this medically necessary service. Establishing and facilitating communities of practice is especially important for new primary care providers.
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Affiliation(s)
- Kathryn J LaRoche
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; School of Public Health, Indiana University, Bloomington, IN, USA
| | | | - Mira Persaud
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.
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Soon JA, Whelan AM, Yuksel N, Rafie S. Enhancing access to contraception through pharmacist prescribing across Canada. Can Pharm J (Ott) 2021; 154:356-362. [PMID: 34777642 PMCID: PMC8581806 DOI: 10.1177/17151635211034534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Judith A. Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia
- Department of Family Practice, University of British Columbia
| | | | - Nesé Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Sally Rafie
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, California
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Munro S, Wahl K, Soon JA, Guilbert E, Wilcox ES, Leduc-Robert G, Ansari N, Devane C, Norman WV. Pharmacist dispensing of the abortion pill in Canada: Diffusion of Innovation meets integrated knowledge translation. Implement Sci 2021; 16:76. [PMID: 34344393 PMCID: PMC8330203 DOI: 10.1186/s13012-021-01144-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since Canadian drug regulatory approval of mifepristone for medical abortion in 2015 and its market availability in January 2017, the role of pharmacists in abortion provision has changed rapidly. We sought to identify the factors that influenced the initiation and provision of medical abortion from the perspectives of Canadian pharmacists, bridging two frameworks - Diffusion of Innovation in Health Service Organizations and integrated knowledge translation. METHODS We conducted one-on-one semi-structured interviews with pharmacists residing in Canada who intended to stock and dispense mifepristone within the first year of availability. Our data collection, analysis, and interpretation were guided by reflexive thematic analysis and supported by an integrated knowledge translation partnership with pharmacy stakeholders. RESULTS We completed interviews with 24 participants from across Canada: 33% had stocked and 21% had dispensed mifepristone. We found that pharmacists were willing and able to integrate medical abortion care into their practice and that those who had initiated practice were satisfied with their dispensing experience. Our analysis indicated that several key Diffusion of Innovation constructs impacted the uptake of mifepristone, including: innovation (relative advantage, complexity and compatibility, technical support), system readiness (innovation-system fit, dedicated time, resources), diffusion and dissemination (expert opinion, boundary spanners, champions, social networks, peer opinions), implementation (external collaboration), and linkage. Participants' experiences suggest that integrated knowledge translation facilitated evidence-based changes to mifepristone dispensing restrictions, and communication of those changes to front line pharmacists. CONCLUSIONS We illustrate how Diffusion of Innovation and integrated knowledge translation may work together as complimentary frameworks for implementation science research. Unlike in the USA, UK, and other highly regulated settings globally, pharmacists in Canada are permitted to dispense mifepristone for medical abortion. We contribute to literature that shows that mifepristone dispensed outside of hospitals, clinics, and medical offices is safe and acceptable to both patients and prescribers. This finding is of particular importance to the current COVID-19 pandemic response and calls for continued and equitable access to abortion care in primary practice.
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Affiliation(s)
- Sarah Munro
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada. .,Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kate Wahl
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edith Guilbert
- Department of Obstetrics, Gynaecology and Reproduction, Laval University, Quebec City, Quebec, Canada
| | - Elizabeth S Wilcox
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Genevieve Leduc-Robert
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadra Ansari
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Courtney Devane
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Stone RH, Rafie S. Medication abortion: Advocating for mifepristone dispensing by pharmacists. Contraception 2021; 104:31-32. [DOI: 10.1016/j.contraception.2021.04.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
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Rebic N, Munro S, Norman WV, Soon JA. Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing. Can Pharm J (Ott) 2021; 154:166-174. [PMID: 34104270 PMCID: PMC8165881 DOI: 10.1177/17151635211005503] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Nevena Rebic
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, BC
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
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Munro S, Guilbert E, Wagner MS, Wilcox ES, Devane C, Dunn S, Brooks M, Soon JA, Mills M, Leduc-Robert G, Wahl K, Zannier E, Norman WV. Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study. Ann Fam Med 2020; 18:413-421. [PMID: 32928757 PMCID: PMC7489974 DOI: 10.1370/afm.2562] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 01/21/2020] [Accepted: 02/11/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Edith Guilbert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Marie-Soleil Wagner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Elizabeth S Wilcox
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Courtney Devane
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Sheila Dunn
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Melissa Brooks
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Judith A Soon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Megan Mills
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Genevieve Leduc-Robert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Erik Zannier
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.)
| | - Wendy V Norman
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.).
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LaRoche KJ, Foster AM. “It gives you autonomy over your own choices”: A qualitative study of Canadian abortion patients’ experiences with mifepristone and misoprostol. Contraception 2020; 102:61-65. [DOI: 10.1016/j.contraception.2020.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022]
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Dineley B, Munro S, Norman WV. Leadership for success in transforming medical abortion policy in Canada. PLoS One 2020; 15:e0227216. [PMID: 31914156 PMCID: PMC6948737 DOI: 10.1371/journal.pone.0227216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/13/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives Mifepristone was approved for use in medical abortion by Health Canada in 2015. Approval was accompanied by regulations that prohibited pharmacist dispensing of the medication. Reproductive health advocates in Canada recognized this regulation would limit access to medical abortion and successfully worked to have this regulation removed in 2017. The purpose of this study was to assess the leadership involved in changing these regulations so that the success may be replicated by other groups advocating for health policy change. Methods This study involved a mixed methods instrumental design in the context of British Columbia, Canada. Our data collection included: a) interviews with seven key individuals, representing the organizations that worked in concert for change to Canadian mifepristone regulations, and b) document analysis of press articles, correspondence, briefing notes, and meeting minutes. We conducted a thematic analysis of transcripts of audio-recorded interviews. We identified strengths and weaknesses of the team dynamic using the Develop Coalitions, Achieve Results and Systems Transformation domains of the LEADS Framework. Results Our analysis of participant interviews indicates that autonomy, shared values, and clarity in communication were integral to the success of the group’s work. Analysis using the LEADS Framework showed that individuals possessed many of the capabilities identified as being necessary for successful health policy leadership. A lack of post-project assessment was identified as a possible limitation and could be incorporated in future work to strengthen dynamics especially when a desired outcome is not achieved. Document analysis provided a clear time-line of the work completed and suggested that strong communication between team members was another key to success. Conclusions The results of our analysis of the interviews and documents provide valuable insight into the workings of a successful group committed to a common goal. The existing collegial and trusting relationships between key stakeholders allowed for interdisciplinary collaboration, rapid mobilization, and identification of issues that facilitated successful Canadian global-first deregulation of mifepristone dispensing.
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Affiliation(s)
- Brigid Dineley
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Sarah Munro
- Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), Vancouver, Canada
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, England
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16
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Wagner MS, Munro S, Wilcox ES, Devane C, Norman WV, Dunn S, Soon JA, Guilbert É. Barriers and Facilitators to the Implementation of First Trimester Medical Abortion With Mifepristone in the Province of Québec: A Qualitative Investigation. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2020; 42:576-582. [PMID: 31924442 DOI: 10.1016/j.jogc.2019.10.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mifepristone became available in Canada in January 2017, but provincial medical policy delayed its use for medical abortion (MA) in Québec for 1 year. The objective of this study was to identify barriers and facilitators experienced by physicians who could potentially provide this newer abortion practice in Québec. METHODS This study was part of the Canadian Contraception and Abortion Research Team-Mifepristone Implementation Study, an observational, prospective, mixed-methods study. Interviews were conducted with physicians representing all health regions of Québec. Using thematic analysis guided by diffusion of innovation theory, the study identified key barriers and facilitators to implementation. RESULTS From January 2017 to March 2018, study investigators interviewed 25 family physicians and 12 obstetrician-gynaecologists. Most were women (81%), over 40 years old (65%), with >20 years in practice since residency (49%). Less than half of the sample provided abortion services (41%), and only 8% provided MA with mifepristone. Key barriers to implementation were: (1) uncertainty or confusion about policies regarding MA, (2) lack of human resources or support from colleagues, (3) uncertainty about product distribution, (4) confusion about professional collaboration, and (5) lack of local infrastructure. Key facilitators were: (1) perception of support and influence from colleagues, (2) previous experience with provision of first trimester MA, (3) requests for first trimester MA by patients or other physicians, and (4) knowledge of research on mifepristone MA. CONCLUSION Despite Health Canada's approval of mifepristone in Canada and supportive federal policies for provision of MA in primary care, physicians in the province of Québec face onerous barriers to the practice of mifepristone MA.
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Affiliation(s)
- Marie-Soleil Wagner
- Department of Obstetrics and Gynaecology, University of Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC
| | - Elizabeth S Wilcox
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC
| | - Courtney Devane
- Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto, Toronto, ON; Women's College Research Institute, Toronto, ON
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC
| | - Édith Guilbert
- Department of Obstetrics and Gynaecology, Université Laval, Centre Hospitalier Universitaire de Québec, Québec, QC.
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17
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LaRoche KJ, Labeca-Gordon IN, Foster AM. How did the introduction of mifepristone impact the availability of abortion care in Ottawa? A qualitative study with abortion patients. Facets (Ott) 2020. [DOI: 10.1139/facets-2020-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction ( n = 20) and after mifepristone–misoprostol became available ( n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.
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Affiliation(s)
- Kathryn J. LaRoche
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Department of Anthropology, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Angel M. Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 6N5, Canada
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18
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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.
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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
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19
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Shaw D, Norman WV. When there are no abortion laws: A case study of Canada. Best Pract Res Clin Obstet Gynaecol 2019; 62:49-62. [PMID: 31281015 DOI: 10.1016/j.bpobgyn.2019.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/19/2019] [Accepted: 05/20/2019] [Indexed: 10/26/2022]
Abstract
Canada decriminalized abortion, uniquely in the world, 30 years ago. We present the timeline of relevant Canadian legal, political, and policy events before and since decriminalization. We assess implications for clinical care, health service and systems decisions, health policy, and the epidemiology of abortion in the absence of criminal legislation. As the criminal abortion law was struck down, dozens of similar private member's bills, and one government bill, have been proposed, but none were passed. Key findings include that initially Canadian provinces attempted to provide restrictive regulations and legislation, all of which have been revoked and largely replaced with supportive policies that improve equitable, accessible, state-provided abortion service. Abortion rates have been stable over 30 years since decriminalization, and a falling proportion of abortions occur late in the second trimester. Canada demonstrates that abortion care can safely and effectively be regulated as a normal component of usual medical care.
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Affiliation(s)
- Dorothy Shaw
- University of British Columbia, Vancouver, Canada
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20
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Medication abortion: Potential for improved patient access through pharmacies. J Am Pharm Assoc (2003) 2018; 58:377-381. [PMID: 29752204 DOI: 10.1016/j.japh.2018.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/14/2018] [Accepted: 04/04/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To discuss the potential for improving access to early abortion care through pharmacies in the United States. SUMMARY Despite the growing use of medications to induce termination of early pregnancy, pharmacist involvement in abortion care is currently limited. The Food and Drug Administration's Risk Evaluation and Mitigation Strategy (REMS) for Mifeprex® (mifepristone 200 mg), the principal drug used in early medication abortion, prohibits the dispensing of the drug by prescription at pharmacies. This commentary reviews the pharmacology of medication abortion with the use of mifepristone and misoprostol, as well as aspects of service delivery and data on safety, efficacy, and acceptability. Given its safety record, mifepristone no longer fits the profile of a drug that requires an REMS. The recent implementation of pharmacy dispensing of mifepristone in community pharmacies in Australia and some provinces of Canada has improved access to medication abortion by increasing the number of medication abortion providers, particularly in rural areas. CONCLUSION Provision of mifepristone in pharmacies, which involves dispensing and patient counseling, would likely improve access to early abortion in the United States without increasing risks to women.
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