Practice nurse provision of early medical abortion in general practice: opportunities and limitations

Abstract

Approximately one in three Australian women with an unintended pregnancy will have an abortion, yet significant barriers remain to ensure the delivery of equitable and timely medical abortion services, including lack of trained providers, high out-of-pocket costs, abortion stigma, conscientious objection and large geographical distance to services. Practice nurses can be suitably trained to provide early medical abortion in general practice; however, there remain several key limitations to the implementation of nurse-led models of care. This forum article discusses these limitations, including issues concerning legislation, funding models, lack of access to medical abortion training, practice structure and systems, and makes recommendations as to how increased access to medical abortion in Australia can be achieved.

“Almost like it was really underground”: a qualitative study of women’s experiences locating services for unintended pregnancy in a rural Australian health system

“…Already in an exploratory phase in Australia is the development of nurse-led models of abortion care designed to alleviate demand on GPs and enable greater access for rural women. 50 , 51 However, improvements to rural women’s reproductive health including abortion are not the responsibility of individual rurally based primary care practitioners, nurses or GPs. Rather, the findings in this study point to an urgent need for systemic repositioning of unintended pregnancy and abortion, out of the shadows of the health system and into the mainstream.…”

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

“…47 A detailed protocol for this activity is described in Moulton et al 47 Intervention support 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 workflows 48 ; 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.…”

Improving the provision of preconception care in Australian general practice through task-sharing with practice nurses

“…In Australia, approximately 14 000 PNs work within general practice and around 63% of general practices employ at least one PN (Lane et al 2017), who could contribute to PCC services. Many PNs in Australia contribute to the provision of some sexual and reproductive healthcare services, including performing cervical screening tests, community education, distributing education resources and screening for sexually transmissible infections (Abbott et al 2013;Moulton et al 2021); however, they are often underutilised in the provision of the range of sexual and reproductive health services that are within their scope of practice, including PCC (Moulton et al 2021). Women, PNs and GPs are receptive towards the idea of sharing the provision of PCC services between PNs and GPs (Hampton and Mazza 2015;Walker et al 2021), and women perceive PNs to be approachable and understanding when discussing lifestyle factors (Mitchell et al 2011).…”