Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada (S.M., K.W.); Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada (S.M, E.S.W.); Department of Obstetrics and Gynaecology, Laval University, Quebec City, Quebec, Canada (E.G.); Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada (M.W.); School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada (E.S.W.); School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada (C.D.); Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada (S.D.); Women's College Research Institute, Toronto, Ontario, Canada (S.D.); Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada (M.B.); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada (J.A.S.); Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (M.M., G.L., E.Z); Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada (W.V.N.); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom (W.V.N.).
Ann Fam Med. 2020 Sep;18(5):413-421. doi: 10.1370/afm.2562.
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.
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.
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.
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.
加拿大的计划生育健康服务一直存在供应不足和不公平的问题。2015 年 7 月，加拿大卫生部批准米非司酮（药物流产的金标准），这为解决这一问题提供了一个潜在的解决方案。我们旨在调查影响加拿大卫生专业人员成功开展和持续提供药物流产服务的因素，以及这些因素与加拿大各地的堕胎政策、系统和服务获取之间的关系。
我们在加拿大医疗保健环境中，对提供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全国性的 1 对 1 半结构式访谈。我们的数据分析、主题分析和解释均以创新扩散理论为指导。
我们采访了 90 名参与者，其中包括农村从业者和没有堕胎经验的人。在研究过程中，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，且与省级许可标准不一致，从而限制了患者的获取途径。一旦放宽限制，剩余的因素主要与当地和区域实施过程有关。参与者强烈认为米非司酮是加拿大药物流产的新标准，也属于初级保健实践的范围。
加拿大卫生部取消米非司酮的限制措施，促进了初级保健环境中堕胎护理的实施。我们的研究结果是独特的，因为加拿大是第一个通过基于证据的米非司酮监管放宽，在初级保健中提供药物流产的国家。
