A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study

Abstract

Background Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l’avortement (CAPS-CPCA) VCoP and explore physicians’ experience with CAPS-CPCA and their views on its value in supporting implementation. Methods This was a mixed methods intrinsic case study of Canadian health care providers’ use and physicians’ perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians’ characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians’ experiences and perceptions of the VCoP. Results From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6%) completed a baseline survey. Of these 222 respondents, 156 (70.3%) were family physicians, 170 (80.2%) were women, and 78 (35.1%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project’s knowledge translation activities with policy makers to mitigate these barriers. Conclusions A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028443

Dispensing mifepristone for medical abortion in Canada: Pharmacists’ experiences of the first year

“…This study is part of our program of research investigating implementation of mifepristone in Canada. 5 - 7 , 11 - 15 …”

“…Further support for implementation of the new practice was provided by a variety of resources and “Ask an Expert” features on the Canadian Abortion Providers Support ( www.CAPS-CPCA.ubc.ca ) virtual community of practice platform. 7 …”

Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice

“…Implementing the nurse-led model in each practice involves engaging a range of stakeholders with varying needs and capabilities. Intervention support will include addressing gaps in clinical knowledge and establishing or altering practice systems and workflows48; and offering continued education and peer-support to address emerging clinical concerns and build clinician confidence in implementing the model 49. We will use a ‘bundle’ of implementation methods, with demonstrated feasibility from our previous studies,36 50 to support the implementation and delivery of the nurse-led model of care.…”

“…Participation in an online community of practice (CoP): The Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) is a national online community for GPs, PNs and pharmacists, that has been modelled after a successful Canadian CoP,49 and provides resources, training and online clinical support and advice regarding provision of LARC and medical abortion services. By creating professional networks of healthcare providers who share clinical and experiential knowledge to foster learning, participation in AusCAPPS can help overcome isolation in management of clinical problems, and aid implementation of new models of care 52.…”

Advancing Reproductive Health through Policy-Engaged Research in Abortion Care

“…Other factors-vocal champions, supportive interprofessional health provider networks, funding policies, and practice supports-were also critical across different levels of the health system to support uptake. 34,71 For instance, while the national outlook for abortion access in Canada is positive, there remain jurisdictional barriers to access of mifepristone medication abortion in the province of Quebec. The College of physicians of Quebec (CMQ) continues to require several of the restrictions at a provincial level that Health Canada removed federally, including mandatory clinical training in surgical abortion before providing mifepristone, restricting nurse practitioners from autonomous practice by requiring them to prescribe under the supervision of a physician who performs abortions, and the requirement for a mandatory dating ultrasound.…”