Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study
Perspectives Among Canadian Physicians on Factors Influencing Implementation of Mifepristone Medical Abortion: A National Qualitative Study
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DOI：
10.1370/afm.2562
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发表时间：
2020-09-01
影响因子：
4.4
通讯作者：
Norman, Wendy, V
中科院分区：
文献类型：
--
作者：
Munro, Sarah;Guilbert, Edith;Norman, Wendy, V
在加拿大，获得计划生育保健服务的机会历来不充分和不公平。2015年7月，加拿大卫生部批准了药物流产的黄金标准米非司酮，由此出现了一个潜在的解决方案。我们试图调查影响加拿大卫生专业人员成功启动和持续提供药物流产服务的因素，以及这些因素如何与加拿大各地的流产政策、系统和服务获取相关。方法：我们对加拿大卫生保健机构中提供堕胎服务和不提供堕胎服务的医生以及卫生系统利益相关者进行了1对1的半结构化访谈。我们的数据收集、专题分析和解释以创新扩散理论为指导。结果对90名受访人员进行了访谈，其中包括农村从业人员和无人工流产经历者。在我们的研究过程中，加拿大卫生部取消了米非司酮的限制。我们的研究结果表明，加拿大卫生部最初的限制措施阻碍了医生提供米非司酮，并且与省级许可标准不一致，从而限制了患者获得米非司酮。一旦解除管制，其余因素主要与地方和区域的执行过程有关。与会者强烈认为，米非司酮是加拿大药物流产的新护理标准，属于初级保健实践的范畴。结论加拿大卫生部取消米非司酮限制有助于在初级保健机构实施流产护理。我们的结果是独特的，因为加拿大是第一个通过以证据为基础的米非司酮放松管制促进在初级保健中提供药物流产的国家。
PURPOSE Access to family planning health services in Canada has been historically inadequate and inequitable. A potential solution appeared when Health Canada approved mifepristone, the gold standard for medical abortion, in July 2015. We sought to investigate the factors that influence successful initiation and ongoing provision of medical abortion services among Canadian health professionals and how these factors relate to abortion policies, systems, and service access throughout Canada.METHODS We conducted 1-on-1 semistructured interviews with a national sample of abortion-providing and nonproviding physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory.RESULTS We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. In the course of our study, Health Canada removed mifepristone restrictions. Our results suggest that Health Canada's initial restrictions discouraged physicians from providing mifepristone and were inconsistent with provincial licensing standards, thereby limiting patient access. Once deregulated, remaining factors were primarily related to local and regional implementation processes. Participants held strong perceptions that mifepristone was the new standard of care for medical abortion in Canada and within the scope of primary care practice.CONCLUSION Health Canada's removal of mifepristone restrictions facilitated the implementation of abortion care in the primary care setting. Our results are unique because Canada is the first country to facilitate provision of medical abortion in primary care via evidence-based deregulation of mifepristone.