Marie-Soleil Wagner1, Sarah Munro2, Elizabeth S Wilcox3, Courtney Devane4, Wendy V Norman5, Sheila Dunn6, Judith A Soon7, Édith Guilbert8. 1. Department of Obstetrics and Gynaecology, University of Montréal, Centre Hospitalier Universitaire Sainte-Justine, Montréal, QC. 2. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC. 3. Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC; School of Population and Public Health, University of British Columbia, Vancouver, BC. 4. Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, BC. 5. Department of Family Practice, University of British Columbia, Vancouver, BC; Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom. 6. Department of Family and Community Medicine, University of Toronto, Toronto, ON; Women's College Research Institute, Toronto, ON. 7. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC. 8. Department of Obstetrics and Gynaecology, Université Laval, Centre Hospitalier Universitaire de Québec, Québec, QC. Electronic address: edith.guilbert@inspq.qc.ca.
Abstract
OBJECTIVE: Mifepristone became available in Canada in January 2017, but provincial medical policy delayed its use for medical abortion (MA) in Québec for 1 year. The objective of this study was to identify barriers and facilitators experienced by physicians who could potentially provide this newer abortion practice in Québec. METHODS: This study was part of the Canadian Contraception and Abortion Research Team-Mifepristone Implementation Study, an observational, prospective, mixed-methods study. Interviews were conducted with physicians representing all health regions of Québec. Using thematic analysis guided by diffusion of innovation theory, the study identified key barriers and facilitators to implementation. RESULTS: From January 2017 to March 2018, study investigators interviewed 25 family physicians and 12 obstetrician-gynaecologists. Most were women (81%), over 40 years old (65%), with >20 years in practice since residency (49%). Less than half of the sample provided abortion services (41%), and only 8% provided MA with mifepristone. Key barriers to implementation were: (1) uncertainty or confusion about policies regarding MA, (2) lack of human resources or support from colleagues, (3) uncertainty about product distribution, (4) confusion about professional collaboration, and (5) lack of local infrastructure. Key facilitators were: (1) perception of support and influence from colleagues, (2) previous experience with provision of first trimester MA, (3) requests for first trimester MA by patients or other physicians, and (4) knowledge of research on mifepristone MA. CONCLUSION: Despite Health Canada's approval of mifepristone in Canada and supportive federal policies for provision of MA in primary care, physicians in the province of Québec face onerous barriers to the practice of mifepristone MA.
OBJECTIVE:Mifepristone became available in Canada in January 2017, but provincial medical policy delayed its use for medical abortion (MA) in Québec for 1 year. The objective of this study was to identify barriers and facilitators experienced by physicians who could potentially provide this newer abortion practice in Québec. METHODS: This study was part of the Canadian Contraception and Abortion Research Team-Mifepristone Implementation Study, an observational, prospective, mixed-methods study. Interviews were conducted with physicians representing all health regions of Québec. Using thematic analysis guided by diffusion of innovation theory, the study identified key barriers and facilitators to implementation. RESULTS: From January 2017 to March 2018, study investigators interviewed 25 family physicians and 12 obstetrician-gynaecologists. Most were women (81%), over 40 years old (65%), with >20 years in practice since residency (49%). Less than half of the sample provided abortion services (41%), and only 8% provided MA with mifepristone. Key barriers to implementation were: (1) uncertainty or confusion about policies regarding MA, (2) lack of human resources or support from colleagues, (3) uncertainty about product distribution, (4) confusion about professional collaboration, and (5) lack of local infrastructure. Key facilitators were: (1) perception of support and influence from colleagues, (2) previous experience with provision of first trimester MA, (3) requests for first trimester MA by patients or other physicians, and (4) knowledge of research on mifepristone MA. CONCLUSION: Despite Health Canada's approval of mifepristone in Canada and supportive federal policies for provision of MA in primary care, physicians in the province of Québec face onerous barriers to the practice of mifepristone MA.
Authors: Regina M Renner; Madeleine Ennis; Damien Contandriopoulos; Edith Guilbert; Sheila Dunn; Janusz Kaczorowski; Elizabeth K Darling; Arianne Albert; Claire Styffe; Wendy V Norman Journal: CMAJ Open Date: 2022-09-27
Authors: Sheila Dunn; Sarah Munro; Courtney Devane; Edith Guilbert; Dahn Jeong; Eleni Stroulia; Judith A Soon; Wendy V Norman Journal: J Med Internet Res Date: 2022-05-05 Impact factor: 7.076
Authors: Sarah Munro; Kate Wahl; Judith A Soon; Edith Guilbert; Elizabeth S Wilcox; Genevieve Leduc-Robert; Nadra Ansari; Courtney Devane; Wendy V Norman Journal: Implement Sci Date: 2021-08-03 Impact factor: 7.327