Primary care providers’ knowledge, attitudes and practices of medical abortion: a systematic review

Subasinghe, Asvini K; Deb, Seema; Mazza, Danielle

doi:10.1136/bmjsrh-2019-200487

Cited by 18 publications

(26 citation statements)

References 26 publications

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“…Although the Therapeutic Goods Administration (TGA) approved mifepristone for use as a medical abortifacient during early pregnancy in 2012 1 and MS‐2 Step (composite regimen of mifepristone and misoprostol) has been subsidised by the Pharmaceutical Benefits Scheme since 2015, 1 integration of early medical abortion into primary health care has been slow 4 . In December 2020, only 2841 of 29 017 registered GPs were active prescribers of MS‐2 Step, and 5347 of 32 393 registered pharmacists were active dispensers 5…”

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confidence: 99%

Early medical abortion services provided in Australian primary care

Subasinghe

McGeechan

Moulton

et al. 2021

Medical Journal of Australia

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Objectives To examine primary care provision of early medical abortion services in Australia. Design Cross‐sectional study; analysis of Pharmaceutical Benefits Scheme (PBS) dispensing data. Setting, participants Women of child‐bearing age (15–54 years), Australia, 2015–2019. Main outcome measures Age‐standardised rates of MS‐2 Step prescriptions dispensed by year for 2015–2019, and age‐standardised rates by state, remoteness area, and level 3 statistical areas (SA3s) for 2019. Numbers and proportions of SA3s in which MS‐2 Step was not prescribed by a GP or dispensed by a community pharmacy during 2019 (unweighted and weighted by number of women of reproductive age), by state and remoteness area. Results During 2015–2019, 91 643 PBS prescriptions for MS‐2 Step were dispensed; the national age‐standardised rate increased from 1.63 in 2015 to 3.79 prescriptions per 1000 women aged 15–54 years in 2019. In 2019, rates were higher in outer regional Australia (6.53 prescriptions per 1000 women aged 15–54 years) and remote Australia (6.02 per 1000) than in major cities (3.30 per 1000). However, about 30% of women in Australia lived in SA3s in which MS‐2 Step had not been prescribed by a GP during 2019, including about 50% of those in remote Australia. Conclusions The rate of early medical abortion is greater among women in remote, outer regional, and inner regional Australia than in major cities, but a considerable proportion of women live in areas in which MS‐2 Step was not locally prescribed or dispensed during 2019. Supporting GPs in the delivery of early medical abortion services locally should be a focus of health policy.

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Early medical abortion services provided in Australian primary care

Subasinghe

McGeechan

Moulton

et al. 2021

Medical Journal of Australia

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“…A study conducted in 23 medical students in India revealed that the lack of knowledge regarding the procedure and the current law of the country contributed to their disapproval of pregnancy terminations [29]. Moreover, appropriate knowledge will support primary care providers and nurses in delivering medical abortion services and increasing access for women [30].…”

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confidence: 99%

Attitudes and Opinions of Young Gynecologists on Pregnancy Termination: Results of a Cross-Sectional Survey in Poland

Zaręba

Rosa

Kołb-Sielecka

et al. 2020

IJERPH

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Background: This paper aims to explore the attitudes and opinions of a group of Polish young gynecologists toward pregnancy termination. Method: An anonymous questionnaire was completed by physicians who participated in obligatory trainee courses held in 2019 in Warsaw. Results: The study group included 71 physicians with an average age of 29 years (SD 3.05). A considerable number of the physicians accepted terminations for medical reasons up to the end of pregnancy, especially in cases of lethal defects (46%) and a serious disease in the mother (34%). Only 6% of the group of gynecologists not performing terminations claimed that the procedure was contrary to their conscience, and 62% of them stated that such procedures were not performed at their hospital. Terminations would be performed by 90% of the respondents in cases of lethal defects of the fetus and by 80% if severe irreversible fetal defects were diagnosed. Conclusions: The main problem associated with the inaccessibility of pregnancy termination in Poland is not linked to individuals, meaning medical personnel and the possibility of invoking the conscience clause, but probably to the lack of approval for terminations granted by hospital supervisors. Adequate knowledge on pregnancy termination procedures, fetal defects, and diseases in the mother translated into the changes of opinions on pregnancy terminations.

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“…Studies on pharmacists' knowledge of mifepristone dispensing have been conducted in countries with regulations that are different from those in the United States, where pharmacists are often the first point of care. [18][19][20] Pharmacists' perspectives on dispensing mifepristone for medication abortion are largely missing from the literature, even internationally. 19,21,22 The purpose of this analysis was to assess the feasibility of the model by measuring the differences in pharmacists' knowledge about medication abortion and their perspectives on mifepristone dispensing before and after the intervention, as well as the proportion of pharmacists who refused to dispense mifepristone to patients.…”

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confidence: 99%

Pharmacists’ knowledge, perspectives, and experiences with mifepristone dispensing for medication abortion

Kaller¹,

Morris²,

Biggs³

et al. 2021

Journal of the American Pharmacists Association

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Background: The U.S. Food and Drug Administration (FDA) restricts dispensing of mifepristone for medication abortion to certified health care providers at clinical facilities, thus prohibiting pharmacist dispensing. Allowing mifepristone dispensing by pharmacists could improve access to medication abortion. Objective: To assess the feasibility of pharmacists dispensing mifepristone to patients who have undergone evaluation for eligibility and counseling for medication abortion by a clinician. Methods: Before providing a study training on medication abortion, we administered baseline surveys to pharmacists who participated in a multisite mifepristone-dispensing intervention. The survey assessed medication abortion knowledgedusing a 15-item scoredand perceptions about the benefits and challenges of the model. We administered follow-up surveys in the study's final month that also assessed the pharmacists' satisfaction and experiences with mifepristone dispensing. To investigate the association of the study intervention with the pharmacists' knowledge, perceptions, and experiences dispensing mifepristone, we conducted multivariable linear regression analyses using generalized estimating equation models, accounting for clustering by individual. Results: Among the 72 pharmacists invited from 6 pharmacies, 47 (65%) completed the baseline surveys, and 56 (78%) received training. At the study's end (mean 18 months later), 43 of the 56 pharmacists who received training (77%) completed the follow-up surveys. At followup, 36 (83%) respondents were very or somewhat satisfied with mifepristone dispensing, and 24 (56%) reported experiencing no challenges dispensing mifepristone. Four (6%) of the 72 pharmacists invited objected to participating in mifepristone dispensing. In regression analyses, average knowledge scores, perceived ease of implementation, and level of support for the pharmacist-dispensing model were higher at follow-up (P < 0.001). Conclusion: Most pharmacists were willing to be trained, dispensed mifepristone with few challenges when given the opportunity, were satisfied with the model, and had higher knowledge levels at follow-up. Our findings support removal of FDA's restriction on pharmacist dispensing of mifepristone.

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Primary care providers’ knowledge, attitudes and practices of medical abortion: a systematic review

Cited by 18 publications

References 26 publications

Early medical abortion services provided in Australian primary care

Early medical abortion services provided in Australian primary care

Attitudes and Opinions of Young Gynecologists on Pregnancy Termination: Results of a Cross-Sectional Survey in Poland

Pharmacists’ knowledge, perspectives, and experiences with mifepristone dispensing for medication abortion

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