‘…a one stop shop in their own community’: Medical abortion and the role of general practice

Newton, Danielle; Bayly, Christine; McNamee, Kathleen; Bismark, Marie; Hardiman, Annarella; Webster, Amy; Keogh, Louise

doi:10.1111/ajo.12507

Cited by 21 publications

(22 citation statements)

References 22 publications

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“…Our research found general agreement that abortion is an essential service which is consistent with recent Australian research from the state of Victoria [23]. However, most of the GPs interviewed did not want to be a MTOP provider and felt that it was a stigmatised service.…”

Section: Discussionsupporting

confidence: 87%

“…This highlights the need for GP peer networks and information that strikes a balance between publicly available information and privacy concerns to improve referral pathways from GP non providers to GP MTOP providers and to a public hospital if required. In line with other studies, GP MTOP providers also noted the need to develop key relationships with local social workers, psychologists, women’s health services, pharmacists and ultrasound providers [23, 28]. …”

Section: Discussionsupporting

confidence: 68%

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Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

et al. 2017

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BackgroundAustralian Government approval in 2012 for the use of mifepristone and misoprostol for medical termination of pregnancy (MTOP) allows general practitioners (GPs) to provide early gestation abortion in primary care settings. However, uptake of the MTOP provision by GPs appears to be low and the reasons for this have been unclear. This study investigated the provision of and referral for MTOP by GPs.MethodsWe undertook descriptive-interpretive qualitative research and selected participants for diversity using a matrix. Twenty-eight semi-structured interviews and one focus group (N = 4), were conducted with 32 GPs (8 MTOP providers, 24 non MTOP providers) in New South Wales, Australia. Interviews were recorded and transcribed verbatim. A framework to examine access to abortion services was used to develop the interview questions and emergent themes identified thematically.ResultsThree main themes emerged: scope of practice; MTOP demand, care and referral; and workforce needs. Many GPs saw abortion as beyond the scope of their practice (i.e. a service others provide in specialist private clinics). Some GPs had religious or moral objections; others regarded MTOP provision as complicated and difficult. While some GPs expressed interest in MTOP provision they were concerned about stigma and the impact it may have on perceptions of their practice and the views of colleagues. Despite a reported variance in demand most MTOP providers were busy but felt isolated. Difficulties in referral to a local public hospital in the case of complications or the provision of surgical abortion were noted.ConclusionsExploring the factors which affect access to MTOP in general practice settings provides insights to assist the future planning and delivery of reproductive health services. This research identifies the need for support to increase the number of MTOP GP providers and for GPs who are currently providing MTOP. Alongside these actions provision in the public sector is required. In addition, formalised referral pathways to the public sector are required to ensure timely care in the case of complications or the provision of surgical options. Leadership and coordination across the health sector is needed to facilitate integrated abortion care particularly for rural and low income women.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 68%

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

et al. 2017

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“…The interview covered participants' experiences providing abortion services, their role in the 2008 law reform, their views of both the intent and outcomes of abortion law reform, and remaining challenges. They were also asked about their experience of medical abortion and their views on the role of general practitioners in provision 19 20. Interviews were conducted by DN, and lasted between 30 minutes and 2 hours; de-identified audio-recordings were transcribed verbatim.…”

Section: Methodsmentioning

confidence: 99%

Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia

Keogh

Newton

Bayly

et al. 2016

J Fam Plann Reprod Health Care

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“…The legal differences and ambiguities in abortion laws across Australian jurisdictions, together with anti‐abortion views and the fear of stigma or harassment, can affect the willingness of doctors to provide abortions . Abortion provision remains predominantly confined to private clinics in metropolitan areas, and abortion access for women from Australia's regional and rural areas can therefore be highly restricted . One approach to improve this inequitable situation is to increase the use of medication abortion (MA) in the primary health care (PHC) sector.…”

Section: Introductionmentioning

confidence: 99%

“…This approach can complement two other currently applied MA provision models in Victoria: MA provided by Gateway Health, a primary health care service located in northeast Victoria, and MA provided through direct‐to‐consumer telemedicine . Although regional and rural GPs are at the forefront of providing comprehensive sexual and reproductive health care and are usually a woman's first point of contact with the health system, the uptake of MA by the GPs has been slow, even in Victoria where abortion is legal . Further, few primary health care nurses (PHCNs) are currently involved in the medication abortion process, a strategy that has globally become a key solution to improve women's access to safe abortion services .…”

Section: Introductionmentioning

confidence: 99%

Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria

Moel-Mandel

Graham

Taket

2019

Australian J Rural Health

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Objective This study aimed to identify enablers and barriers to the provision of medication abortion in the primary health care setting of regional and rural areas of Victoria, Australia. Design An online cross‐sectional questionnaire was used. Setting Regional and rural areas of Victoria, Australia. Participants Thirty‐nine GPs and 30 primary health care nurses. Main outcome measures Abortion views, medication abortion knowledge and practice, interest in medication abortion training and provision, and perceived uptake barriers. Results Most participants reported being consulted by women with unintended pregnancies and most of them included abortion counselling in their consultation. However, familiarity with provision of medication abortion was limited, and only five GPs and two primary health care nurses were currently medication abortion providers. The majority of participants expressed a high level of interest in receiving medication abortion training, but indicated a wide range of barriers to service provision, such as a lack of training opportunities, legal uncertainties or surgical access concerns in case of complications. Conclusions Findings demonstrate the need for education on medication abortion and training opportunities. Most identified barriers to service uptake are addressable and relate to a lack of local support services, including the absence of a 24‐hour contact advice service, insufficient follow‐up access and a lack of local ultrasound facilities. These barriers require educational programs at professional, organisational and community level to ensure that interested rural and regional primary health care providers can start offering medication abortion for their patients.

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‘…a one stop shop in their own community’: Medical abortion and the role of general practice

Abstract: The application of these findings by relevant health services and agencies has the potential to increase provision of medical abortion services in general practice settings, better meeting the health-care needs of women seeking this service.

Cited by 21 publications

References 22 publications

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

Medical termination of pregnancy in general practice in Australia: a descriptive-interpretive qualitative study

Intended and unintended consequences of abortion law reform: perspectives of abortion experts in Victoria, Australia

Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria

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