Australian women’s experiences of a rural medical termination of pregnancy service: A qualitative study

Chambers, Alana Hulme; Temple-Smith, Meredith; Davidson, A.; Coelli, Lauren; Orr, Catherine; Tomnay, Jane

doi:10.1016/j.srhc.2017.11.008

Cited by 16 publications

(18 citation statements)

References 24 publications

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“…Although international 7,21 and Australian 22 data confirm that women find GP medical abortion generally acceptable, data from the present study suggest that streamlined and ultrasonography-inclusive GP medical abortion models may be more acceptable than the common model. Multiple appointments were perceived to cause dissatisfaction for some women.…”

Section: Discussioncontrasting

confidence: 74%

Providing medical abortion in general practice: General practitioner insights and tips for future providers

2020

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Background and objectiveMedical abortion is safe and effective and, when provided by general practitioners (GPs), can increase access for women. However, little is known about which models Australian GPs use to deliver medical abortion. The aim of this study was to describe GP medical abortion delivery models. MethodsSemi-structured telephone interviews were conducted with GPs providing medical abortion nationwide. Data were transcribed, thematically analysed by two researchers and interpreted using six quality dimensions. ResultsTwenty-five GPs used three medical abortion models in private practice: common, streamlined and ultrasonography-inclusive. The most common model comprised three appointments. Some participants provided medical abortion over 1-2 appointments ('streamlined'), and few provided ultrasonography themselves ('ultrasonography-inclusive'). Clinician networks supported participants and enhanced medical abortion delivery. DiscussionUsing three appointments for delivering medical abortion may be less acceptable and accessible to women than streamlined or ultrasonography-inclusive models. Increased awareness of the alternative medical abortion models may encourage GP medical abortion delivery and increase access for women.ABORTION is a common experience for women globally. In Australia, 16% of women have had an abortion by the age of 34 years. 1 While both surgical and medical methods of abortion are available in Australia, they can be difficult to access, with many women travelling long distances 2 or interstate 3 and incurring high out-of-pocket costs 3,4 to receive abortion care. Provision of medical abortion in general practice can improve access to abortion care. General practices tend to be more proximal than tertiary centres and frequently visited by women, 5 particularly for assistance with pregnancy and family planning issues. 6 There is evidence that women prefer to receive their abortion care from a known health provider, such as a general practitioner (GP). 7 GPs are also well placed to provide other related services such as contraceptive care. Thus, GPs are ideally positioned to provide medical abortion in the community setting.Currently, medical abortifacients in the form of MS-2 Step (mifepristone and misoprostol) are available for GPs to prescribe under the Pharmaceutical Benefits Scheme in all Australian states and territories excluding South Australia (SA). 8 In SA, abortions must occur on hospital grounds, not in a general practice. 8 MS-2 Step can be prescribed at up to nine weeks' gestation. For a GP to legally prescribe medical abortion, they are required to undertake mandatory certification through online training (available at www.ms2step.com.au/register).Although no nationwide data exist, it appears that some Australian GPs are willing to provide medical abortion but do not. 9 Evidence suggests that lack of training, lack of support, fear of or actual stigmatisation and fear of demand are key barriers to GPs establishing and providing medical abortion services, both internati...

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Section: Discussioncontrasting

confidence: 74%

Providing medical abortion in general practice: General practitioner insights and tips for future providers

2020

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“…The MA method, consisting of the sequential combination of mifepristone and misoprostol, can be legally and safely provided in the PHC setting for pregnancies up to 63 days since 2012 . This approach can complement two other currently applied MA provision models in Victoria: MA provided by Gateway Health, a primary health care service located in northeast Victoria, and MA provided through direct‐to‐consumer telemedicine . Although regional and rural GPs are at the forefront of providing comprehensive sexual and reproductive health care and are usually a woman's first point of contact with the health system, the uptake of MA by the GPs has been slow, even in Victoria where abortion is legal .…”

Section: Introductionmentioning

confidence: 99%

“…Further, few primary health care nurses (PHCNs) are currently involved in the medication abortion process, a strategy that has globally become a key solution to improve women's access to safe abortion services . Previous Australian research was limited to studies exploring the provision of MA service, as experienced by women and qualitative studies exploring factors affecting the MA uptake from the perspectives of primary health care providers . To add to the existing literature, this study used a quantitative approach to identify enablers and barriers that determine the decision of GPs and PHCNs from regional and rural areas of Victoria to become an MA provider.…”

Section: Introductionmentioning

confidence: 99%

Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria

Moel-Mandel

Graham

Taket

2019

Australian J Rural Health

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Objective This study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia. Design An online cross‐sectional questionnaire was used. Setting Regional and rural areas of Victoria, Australia. Participants Thirty‐nine GPs and 30 primary health care nurses. Main outcome measures Abortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers. Results Most participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barriers to service provision, such as a lack of training opportunities, legal uncertainties or surgical access concerns in case of complications. Conclusions Findings demonstrate the need for education on medication abortion and training opportunities. Most identified barriers to service uptake are addressable and relate to a lack of local support services, including the absence of a 24‐hour contact advice service, insufficient follow‐up access and a lack of local ultrasound facilities. These barriers require educational programs at professional, organisational and community level to ensure that interested rural and regional primary health care providers can start offering medication abortion for their patients.

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“…15,16 EMA provision is a lengthy procedure and usually requires two or more visits to the health facility, although single consultations are also offered to Australian women who live long distances from a clinic or are close to the 63 days' gestational limit. [17][18][19] A previous paper reported on the…”

Section: Introductionmentioning

confidence: 99%

Identifying barriers and facilitators of full service nurse-led early medication abortion provision: qualitative findings from a Delphi study

Moel-Mandel¹,

Taket²,

Graham³

2021

AJAN

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Objective: To explore factors that can influence implementation of a nurse-led model of care for early medication abortion provision in the primary healthcare setting of regional and rural Victoria, Australia.Background: Global research indicates that an increased involvement of primary healthcare nurses in the delivery of early medication abortion provision has the potential to improve abortion access. In Victoria, access in regional and rural areas is restricted despite abortion being legal. A nurse-led early medication abortion provision model is feasible and can potentially improve the current situation.Study design and methods: An online threeround classic Delphi method was used. This paper reports the qualitative findings. Non-probability sampling techniques were used to recruit a panel of professional experts. Data from the three questionnaires were collected and analysed using thematic analysis. Factors influencing model implementation were categorised into the Capability, Opportunity, Motivation-Behaviour framework.Results: A total of 24 medical and other health professionals participated. They identified a range of factors that can hinder model implementation, including a lack of affordable medication abortion education, no remuneration for nurse-led early medication abortion provision, and concerns related to stigma and support. Discussion and conclusion:Understanding and addressing barriers to model implementation may enable the development of primary healthcare nurses' role in the delivery of early medication abortion provision to improve abortion access. Impact: To improve abortion access in Victoria's under-served regions, the potential of nurse-led early medication abortion provision was explored. Barriers to model implementation relate to a lack of medication abortion education and funding, professional support and stigma concerns. The study identified a range of support elements that would enable primary healthcare nurses to develop new roles and responsibilities in the delivery of medication abortion services.

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Australian women’s experiences of a rural medical termination of pregnancy service: A qualitative study

Cited by 16 publications

References 24 publications

Providing medical abortion in general practice: General practitioner insights and tips for future providers

Providing medical abortion in general practice: General practitioner insights and tips for future providers

Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria

Identifying barriers and facilitators of full service nurse-led early medication abortion provision: qualitative findings from a Delphi study

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