Barriers and Facilitators to the Implementation of First Trimester Medical Abortion With Mifepristone in the Province of Québec: A Qualitative Investigation

Wagner, Marie-Soleil; Munro, Sarah; Wilcox, Elizabeth; Devane, Courtney; Norman, Wendy V.; Dunn, Sheila; Soon, Judith A.; Guilbert, Édith

doi:10.1016/j.jogc.2019.10.037

Cited by 14 publications

(26 citation statements)

References 12 publications

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“…The average number of MIFE-MISO T1 MTOPs provided by our participants did not exceed 27 MTOPs. This low number was corroborated by market shares of MIFE-MISO in 2017-2018 [39] and 2017 termination data showing that during the first year of access, MTOP represented approximately 9% of all TOPs in Quebec [40] compared to 30% or greater in Ontario and British Columbia [16]. As shown in a 2017 worldwide review [23], the proportion of all TOPs that were MTOP increased in most countries (proportions up to 59% in France and to 80% to 90% in Sweden and Finland).…”

Section: Discussionmentioning

confidence: 95%

“…Interviews were conducted with 37 physicians (25 FP and 12 OB). Characteristics of participants have been described in a previous publication [16]. In summary, 81% of participants were females; 46% were 50 years old or older; 43% were working in public TOP clinics; 60% did not provide either T1 MTOP or surgical TOP; and 14% had completed the online MTOP training programme [10].…”

Section: Resultsmentioning

confidence: 99%

“…We (EG & MSW) performed and audiotaped 30-45 min semi-structured interviews in French with family physicians (FP) and obstetricians-gynaecologists (OB) from all Health Regions in Quebec between January and March 2018 (except for one interview in mid-October 2017). Recruitment was performed amongst members of various Quebec medical associations, participants to the quantitative component of the CART-Mife Study, and members of a community of practice for MTOP providers established for the CART-Mife Study (recruitment strategy thoroughly described in a previous publication) [16]. Nurse practitioners were not interviewed because CMQ did not allow them to provide MIFE-MISO without supervision of physicians trained to provide MTOP ( Table 1).…”

Section: Methodsmentioning

confidence: 99%

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Slow implementation of mifepristone medical termination of pregnancy in Quebec, Canada: a qualitative investigation

Guilbert

Wagner

Munro

et al. 2020

The European Journal of Contraception & Reproductive Health

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Objectives: Mifepristone for first-trimester medical termination of pregnancy (MTOP) became available in Quebec in 2018, one year after the rest of Canada. Using the theory of the Diffusion of Innovation (DOI) and the transtheoretical model of change (TTM), we investigated factors influencing the implementation of mifepristone MTOP in Quebec. Material and Methods: Semi-structured interviews were conducted with 37 Quebec physicians in early 2018. Deductive thematic analysis guided by the theory of DOI explored facilitators and barriers to physicians' adoption of mifepristone MTOP. We then classified participants into five stages of mifepristone adoption based on the TTM. Follow-up data collection one year later assessed further adoption. Results: At baseline, three physicians provided mifepristone MTOP (Maintenance) and two were about to start (Action). Thirteen physicians at Preparation and Advanced Contemplation stages intended to start while, within the Slow Contemplation, two intended to start and ten were unsure. Seven had no intention to provide mifepristone MTOP (Pre-Contemplation). Major reported barriers were: complexity of local health care organisations, medical policy restrictions, lack of support, and general uncertainty. One year later, ten physicians provided mifepristone MTOP (including three at baseline) and nine still intended to, while seventeen did not intend to start provision. Seven of sixteen participants (44%) who worked in TOP clinics at baseline were still not providing MTOP with mifepristone one year later. Conclusion: Despite ideological support, mifepristone MTOP uptake in Quebec is slow and laborious, mainly due to restrictive medical policies, vested interests in surgical provision and administrative inertia.

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Section: Discussionmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Slow implementation of mifepristone medical termination of pregnancy in Quebec, Canada: a qualitative investigation

Guilbert

Wagner

Munro

et al. 2020

The European Journal of Contraception & Reproductive Health

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“…As medical abortion counselling may require additional time and resources inadequately reflected in a pharmacist's dispensing fee, our data indicate this may act as an additional barrier to provision for some pharmacists. Ongoing research 3,[32][33][34][35] suggests that 3 years since mifepristone/misoprostol for medical abortion entered the Canadian market in January 2017, uptake continues to be variable across Canada. Several pharmacy managers in our study reported using the Pharmacist Checklist and Resource Guide to train staff pharmacists for medical abortion provision. Indeed, a strength of our study was our integrated knowledge translation strategy for engaging knowledge users throughout the research process.…”

Section: Discussionmentioning

confidence: 99%

“…As medical abortion counselling may require additional time and resources inadequately reflected in a pharmacist’s dispensing fee, our data indicate this may act as an additional barrier to provision for some pharmacists. Ongoing research 3 , 32 - 35 suggests that 3 years since mifepristone/misoprostol for medical abortion entered the Canadian market in January 2017, uptake continues to be variable across Canada.…”

Section: Discussionmentioning

confidence: 99%

Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing

Rebić

Munro²,

Norman

et al. 2021

Can Pharm J

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Advancing Reproductive Health through Policy-Engaged Research in Abortion Care

et al. 2022

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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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Barriers and Facilitators to the Implementation of First Trimester Medical Abortion With Mifepristone in the Province of Québec: A Qualitative Investigation

Cited by 14 publications

References 12 publications

Slow implementation of mifepristone medical termination of pregnancy in Quebec, Canada: a qualitative investigation

Slow implementation of mifepristone medical termination of pregnancy in Quebec, Canada: a qualitative investigation

Pharmacist checklist and resource guide for mifepristone medical abortion: User-centred development and testing

Advancing Reproductive Health through Policy-Engaged Research in Abortion Care

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