What factors influence implementation of mifepristone medical abortion among Canadian physicians? Results of a national qualitative investigation

Abstract

<h3>Objectives</h3> 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. <h3>Methods</h3> We conducted one-on-one semi-structured interviews at baseline (2017) and follow-up (2018) with a national sample of abortion providing and non-providing physicians and health system stakeholders in Canadian health care settings. Our data collection, thematic analysis, and interpretation were guided by Diffusion of Innovation theory. <h3>Results</h3> We conducted interviews with 90 participants including rural practitioners and those with no previous abortion experience. Our results suggest that Health Canada's initial approval included restrictions that were perceived as time-consuming, discouraging to physicians interested in the new practice, in breach of professional privacy, and inconsistent with provincial licensing standards, thereby limiting patient access. After Health Canada's restrictions were removed, implementation challenges revolved around confusion about the changing regulations, waiting for billing codes, varying subsidies for patients in each province, and navigating the unique challenges of practice in low-resource, rural environments. <h3>Conclusions</h3> In the first two years since mifepristone was made available in Canada, rapid regulatory revisions greatly assisted primary care practitioners to implement closer to home abortion care. These changes have led to health care professional perceptions that there are minimal regulatory barriers to medical abortion practice. Our results are unique internationally as Canada is the first nation to facilitate provision of medical abortion in primary care settings through evidence-based deregulation of mifepristone.