Providing accessible medical abortion services in a Victorian rural community: A description and audit of service delivery and contraception follow up

Tomnay, Jane; Coelli, Lauren; Davidson, A.; Chambers, Alana Hulme; Orr, Catherine; Hocking, Jane S

doi:10.1016/j.srhc.2018.04.006

Cited by 16 publications

(20 citation statements)

References 11 publications

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“…Despite the World Health Organization determining ultrasonography non-essential for medical abortion eligibility (following clinical assessment and other investigations), the present findings are consistent with other developed countries' practices, where standard medical abortion protocol requires ultrasonography. 16,23 Current Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) guidelines recommend ultrasonographical examination as mandatory prior to abortion, rather than non-mandatory, 24 despite the fact that some women who live in rural areas find ultrasonography difficult to access. 2 Additional support for GPs to provide ultrasonography-inclusive models, particularly in rural areas, could alleviate ultrasonography-related delays for medical abortion provision.…”

Section: Discussionmentioning

confidence: 99%

“…Previously, Australian medical abortion models have described nurse-led models in which nurses provide most of the counselling, administration and follow-up tasks that comprise provision. 16,17 These nurse-GP models, 16,17 known as 'task-sharing models', have been successfully implemented in community healthcare settings where specific funding is available for those nurses. However, there has not been the same focus on how to implement and sustain medical abortion service delivery in the general practice setting.…”

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confidence: 99%

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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: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

2020

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“…Although in Australia only GPs who have undergone mandatory training are authorised to prescribe MToP, some GPs utilise a nurse-led integrated model of care. In such models the woman’s appointments occur with the nurse and are double-booked with the prescribing GP [ 11 ]. The sessions provided information about MToP procedures, including GP training requirements, the role of GP practices in managing MToP service delivery, and establishing local service systems.…”

Section: Methodsmentioning

confidence: 99%

“…Regulations around the availability of MToP in Australia have changed in recent years. The combination of mifepristone and misoprostol for MToP was approved for use in Australia in 2012 (originally this was for pregnancies of up to 49 days but was later revised to 63 days) and were added to the Commonwealth Pharmaceutical Benefits Scheme in 2013 as a subsidised medicine, reducing the cost of the medication [ 11 ]. In Victoria, MToP can be commenced in a primary care setting or pharmacy and completed in a home environment [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

Chambers

Clune

Tomnay

2018

Int J Equity Health

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BackgroundMedical termination of pregnancy (MToP) is a safe and acceptable abortion option. Depending on country context, MToP can be administered by general practitioners and mid-level healthcare providers in the first and second trimesters of pregnancy. Like other high-income countries, a range of social and structural barriers to MToP service provision exist in Australia. To counter some of these barriers, geographic decentralization of MToP was undertaken in rural Victoria, Australia, through training service providers about MToP to increase service delivery opportunities. The aim of this study was to investigate the factors that enabled and challenged the decentralization process.MethodsFace-to-face and telephone interviews were undertaken between April and June 2016 with a purposeful sample of six training providers and 13 general practitioners (GP) and nurse training participants. Study participants were asked about their perceptions of motivations, enablers and challenges to MToP provision. A published conceptual framework of synergies between decentralization and service delivery was used to analyse the study findings.ResultsThree key themes emerged from the study findings. First, the effort to decentralize MToP was primarily supported by motivations related to making service access more equitable as well as the willingness of training providers to devolve their informal power, in the form of MToP medical expertise, to training participants. Next, the enablers for MToP decentralization included changes in the regulatory environment relating to decriminalization of abortion and availability of required medication, formation of partnerships to deliver training, provision of MToP clinical resources and local collegial support. Finally, challenges to MToP decentralization were few but significant. These included a lack of a state-wide strategy for service provision, provider concerns about coping with service demand, and provider stigma in the form of perceived negative community or collegial attitudes. These were significant enough to create caution for GPs and nurses considering service provision.ConclusionsDecentralization concepts offer an innovative way for reframing and tackling issues associated with improving MToP service delivery. There is scope for more research about MToP decentralization in other country contexts. These findings are important for informing future rural MToP service expansion efforts that improve equity in service access.

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“…To date there has been only one Australian study that has explored nurses' role in the provision of EMA in regional and rural Victoria, where abortion access, despite abortion reform, remains limited. 23 The present paper aimed to add to the literature by reporting the qualitative findings of a previous Delphi study, 22…”

Section: What This Paper Addsmentioning

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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Providing accessible medical abortion services in a Victorian rural community: A description and audit of service delivery and contraception follow up

Abstract: Provision of accessible, affordable MToP through an integrated primary health service is one strategy to address access inequity in regional areas.

Cited by 16 publications

References 11 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

Medical termination of pregnancy service delivery in the context of decentralization: social and structural influences

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

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