Sarah Munro1,2, Kate Wahl3, Judith A Soon4, Edith Guilbert5, Elizabeth S Wilcox6, Genevieve Leduc-Robert7, Nadra Ansari8, Courtney Devane9, Wendy V Norman10,11. 1. Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada. sarah.munro@ubc.ca. 2. Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. sarah.munro@ubc.ca. 3. Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 4. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 5. Department of Obstetrics, Gynaecology and Reproduction, Laval University, Quebec City, Quebec, Canada. 6. School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 7. Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 8. Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. 9. School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada. 10. Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada. 11. Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Abstract
BACKGROUND: Since Canadian drug regulatory approval of mifepristone for medical abortion in 2015 and its market availability in January 2017, the role of pharmacists in abortion provision has changed rapidly. We sought to identify the factors that influenced the initiation and provision of medical abortion from the perspectives of Canadian pharmacists, bridging two frameworks - Diffusion of Innovation in Health Service Organizations and integrated knowledge translation. METHODS: We conducted one-on-one semi-structured interviews with pharmacists residing in Canada who intended to stock and dispense mifepristone within the first year of availability. Our data collection, analysis, and interpretation were guided by reflexive thematic analysis and supported by an integrated knowledge translation partnership with pharmacy stakeholders. RESULTS: We completed interviews with 24 participants from across Canada: 33% had stocked and 21% had dispensed mifepristone. We found that pharmacists were willing and able to integrate medical abortion care into their practice and that those who had initiated practice were satisfied with their dispensing experience. Our analysis indicated that several key Diffusion of Innovation constructs impacted the uptake of mifepristone, including: innovation (relative advantage, complexity and compatibility, technical support), system readiness (innovation-system fit, dedicated time, resources), diffusion and dissemination (expert opinion, boundary spanners, champions, social networks, peer opinions), implementation (external collaboration), and linkage. Participants' experiences suggest that integrated knowledge translation facilitated evidence-based changes to mifepristone dispensing restrictions, and communication of those changes to front line pharmacists. CONCLUSIONS: We illustrate how Diffusion of Innovation and integrated knowledge translation may work together as complimentary frameworks for implementation science research. Unlike in the USA, UK, and other highly regulated settings globally, pharmacists in Canada are permitted to dispense mifepristone for medical abortion. We contribute to literature that shows that mifepristone dispensed outside of hospitals, clinics, and medical offices is safe and acceptable to both patients and prescribers. This finding is of particular importance to the current COVID-19 pandemic response and calls for continued and equitable access to abortion care in primary practice.
BACKGROUND: Since Canadian drug regulatory approval of mifepristone for medical abortion in 2015 and its market availability in January 2017, the role of pharmacists in abortion provision has changed rapidly. We sought to identify the factors that influenced the initiation and provision of medical abortion from the perspectives of Canadian pharmacists, bridging two frameworks - Diffusion of Innovation in Health Service Organizations and integrated knowledge translation. METHODS: We conducted one-on-one semi-structured interviews with pharmacists residing in Canada who intended to stock and dispense mifepristone within the first year of availability. Our data collection, analysis, and interpretation were guided by reflexive thematic analysis and supported by an integrated knowledge translation partnership with pharmacy stakeholders. RESULTS: We completed interviews with 24 participants from across Canada: 33% had stocked and 21% had dispensed mifepristone. We found that pharmacists were willing and able to integrate medical abortion care into their practice and that those who had initiated practice were satisfied with their dispensing experience. Our analysis indicated that several key Diffusion of Innovation constructs impacted the uptake of mifepristone, including: innovation (relative advantage, complexity and compatibility, technical support), system readiness (innovation-system fit, dedicated time, resources), diffusion and dissemination (expert opinion, boundary spanners, champions, social networks, peer opinions), implementation (external collaboration), and linkage. Participants' experiences suggest that integrated knowledge translation facilitated evidence-based changes to mifepristone dispensing restrictions, and communication of those changes to front line pharmacists. CONCLUSIONS: We illustrate how Diffusion of Innovation and integrated knowledge translation may work together as complimentary frameworks for implementation science research. Unlike in the USA, UK, and other highly regulated settings globally, pharmacists in Canada are permitted to dispense mifepristone for medical abortion. We contribute to literature that shows that mifepristone dispensed outside of hospitals, clinics, and medical offices is safe and acceptable to both patients and prescribers. This finding is of particular importance to the current COVID-19 pandemic response and calls for continued and equitable access to abortion care in primary practice.
Authors: Edith R Guilbert; Althea S Hayden; Heidi E Jones; Katharine O'Connell White; E Steven Lichtenberg; Maureen Paul; Wendy V Norman Journal: Can Fam Physician Date: 2016-04 Impact factor: 3.275
Authors: Marie-Soleil Wagner; Sarah Munro; Elizabeth S Wilcox; Courtney Devane; Wendy V Norman; Sheila Dunn; Judith A Soon; Édith Guilbert Journal: J Obstet Gynaecol Can Date: 2020-01-08
Authors: Sarah Munro; Edith Guilbert; Marie-Soleil Wagner; Elizabeth S Wilcox; Courtney Devane; Sheila Dunn; Melissa Brooks; Judith A Soon; Megan Mills; Genevieve Leduc-Robert; Kate Wahl; Erik Zannier; Wendy V Norman Journal: Ann Fam Med Date: 2020-09 Impact factor: 5.166
Authors: Mark J Makowsky; Lisa M Guirguis; Christine A Hughes; Cheryl A Sadowski; Nese Yuksel Journal: Implement Sci Date: 2013-09-14 Impact factor: 7.327
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