“One of those areas that people avoid” a qualitative study of implementation in miscarriage management

Blair G Darney,Nancy G Stevens,Sarah W Prager,Deborah Vanderhei,Marcia R Weaver

doi:10.1186/1472-6963-13-123

Abstract

BackgroundMiscarriage is common and often managed by specialists in the operating room despite evidence that office-based manual vacuum aspiration (MVA) is safe, effective, and saves time and money. Family Medicine residents are not routinely trained to manage miscarriages using MVA, but have the potential to increase access to this procedure. This process evaluation sought to identify barriers and facilitators to implementation of office-based MVA for miscarriage in Family Medicine residency sites in Washington State.MethodsThe Residency Training Initiative in Miscarriage Management (RTI-MM) is a theory-based, multidimensional practice change initiative. We used qualitative methods to identify barriers and facilitators to successful implementation of the RTI-MM.ResultsThirty-six RTI-MM participants completed an interview. We found that the common major barriers to implementation were low volume and a perception of miscarriage as emotional and/or like abortion, while the inclusion of support staff in training and effective champions facilitated successful implementation of MVA services.ConclusionPerceived characteristics of the innovation that may conflict with cultural fit must be explicitly addressed in dissemination strategies and support staff should be included in practice change initiatives. Questions remain about how to best support champions and influence perceptions of the innovation. Our study findings contribute programmatically (to improve the RTI-MM), and to broader theoretical knowledge about practice change and implementation in health service delivery.

Highlights

Miscarriage is common and often managed by specialists in the operating room despite evidence that office-based manual vacuum aspiration (MVA) is safe, effective, and saves time and money
MVA is as safe as operating room-based care in samples of women presenting with miscarriage [2] and seeking induced abortion [4,5]
We present our results classified by the conceptual framework as related to the innovation, the dissemination strategy, and the user systems

Summary

Introduction

Miscarriage is common and often managed by specialists in the operating room despite evidence that office-based manual vacuum aspiration (MVA) is safe, effective, and saves time and money. Medicine residents are not routinely trained to manage miscarriages using MVA, but have the potential to increase access to this procedure This process evaluation sought to identify barriers and facilitators to implementation of office-based MVA for miscarriage in Family Medicine residency sites in Washington State. MVA is as safe as operating room-based care in samples of women presenting with miscarriage [2] and seeking induced abortion [4,5], Family medicine residents are not routinely trained in office-based uterine aspiration for miscarriage [10] despite recommendations [11]. Our impact evaluation [13] showed a positive association with physician intent to practice MVA following a training intervention; this process evaluation sought to understand the implementation process—how MVA was or was not incorporated into routine practice— more comprehensively at participating sites

Methods

Results

Discussion

Conclusion