Abstract
BackgroundSince 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.MethodsWe 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.ResultsWe 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.ConclusionsWe 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.
Highlights
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 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
Summary
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. Canada is one of the first pharmaceutically regulated countries in the world to approve pharmacists’ dispensation of mifepristone, the medical abortion pill, directly to patients [1, 2] This task sharing between pharmacists, as experts in medication stocking, dispensing, and counselling, and prescribing healthcare providers is considered preferable for the provision of prescription medications [3,4,5]. In provinces like Quebec and according to its physician’s code of ethics, physicians cannot stock or dispense most prescription medications, including mifepristone, to avoid conflict of interest; only pharmacists can [6,7,8] This evidence- and ethically-based approach stands in contrast to more restrictive first trimester medical abortion regulations in the USA and UK, where mifepristone is dispensed to patients by the authorized prescriber [9, 10]. Pharmacist attitudes toward participation in emergency contraception [15] and other family planning care have been found to be positive [4], indicating potential openness to participating in abortion care
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