Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; School of Public Health, Indiana University, Bloomington, IN, United States.
Planned Parenthood Ottawa, Ottawa, Ontario, Canada.
Contraception. 2022 May;109:37-42. doi: 10.1016/j.contraception.2022.01.002. Epub 2022 Jan 11.
Following the 2017 introduction of mifepristone in Canada and both ensuing regulatory changes and increased demand for medication abortion care, Planned Parenthood Ottawa created the Medical Abortion Access Project (MAAP). This study aimed to document outcomes, identify facilitators and barriers, and distill learnings from an initiative that sought to recruit and support primary care clinicians in providing mifepristone/misoprostol in Canada's capital.
We employed a multi-methods evaluation strategy that included reviewing MAAP-related documents, evaluating the project log, and conducting in-depth interviews with clinicians at 5 sites. In the final analytic phase, we integrated the findings from the different evaluation components.
From May 2017 through July 2018, the MAAP helped 14 primary care facilities in Ottawa become medication abortion providers; 9 began providing mifepristone/misoprostol to existing patients and 5 began offering mifepristone/misoprostol to the public. The program recruited 4 new pharmacies to stock the combination package and trained 2 sonography clinics in abortion-related protocols. Program participants identified patient demand as a key driver of medication abortion provision but required information and logistical support from the MAAP to operationalize service delivery. New abortion providers reflected positively on the community of practice that the MAAP created, which enabled them to offer and receive technical and emotional support from colleagues across the city.
A number of primary care clinicians in Ottawa were able to successfully integrate medication abortion care into their practices with MAAP support. Future research should explore whether this type of community-based intervention can be replicated in other settings.
Evidence-based regulation of mifepristone by health authorities is a critical step to increasing access to medication abortion care. However, deregulation alone was insufficient to integrate medication abortion services into primary care in Ottawa. Community-based programs like the MAAP can help providers make sense of shifting regulations and practice guidelines, overcome logistical barriers, and ultimately increase access to this medically necessary service. Establishing and facilitating communities of practice is especially important for new primary care providers.
在 2017 年米非司酮在加拿大上市以及随之而来的监管变化和对药物流产护理需求增加之后，渥太华计划生育协会创建了医疗流产准入项目（MAAP）。本研究旨在记录结果，确定促进因素和障碍，并从一项旨在招募和支持初级保健临床医生在加拿大首都提供米非司酮/米索前列醇的倡议中汲取经验教训。
我们采用了一种多方法评估策略，包括审查与 MAAP 相关的文件、评估项目日志以及对 5 个地点的临床医生进行深入访谈。在最后分析阶段，我们整合了不同评估部分的发现。
从 2017 年 5 月到 2018 年 7 月，MAAP 帮助渥太华的 14 个初级保健机构成为药物流产提供者；9 个机构开始向现有患者提供米非司酮/米索前列醇，5 个机构开始向公众提供米非司酮/米索前列醇。该计划招募了 4 家新的药店来储备组合包装，并培训了 2 家超声诊所进行与堕胎相关的协议。项目参与者认为患者需求是提供药物流产的关键驱动因素，但需要 MAAP 提供信息和后勤支持才能实现服务提供。新的堕胎提供者对 MAAP 所创建的实践社区给予了积极评价，这使他们能够从全市的同事那里获得技术和情感支持。
在 MAAP 的支持下，渥太华的许多初级保健临床医生能够成功地将药物流产护理纳入他们的实践。未来的研究应该探讨这种基于社区的干预措施是否可以在其他环境中复制。
卫生当局对米非司酮进行循证监管是增加药物流产护理可及性的关键步骤。然而，仅放宽监管不足以将药物流产服务纳入渥太华的初级保健。像 MAAP 这样的基于社区的项目可以帮助提供者理解不断变化的法规和实践指南，克服后勤障碍，并最终增加对这种医学上必要服务的获取。建立和促进实践社区对于新的初级保健提供者尤为重要。
