Grant: Partnerships for Health System Improvement (PHSI)

B.C. Women's Hospital (Vancouver); B.C. Women's Hospital (Vancouver); The College of Family Physicians of Canada (Mississauga, Ont.); Canadian Pharmacists Association (Ottawa, Ontario); Michael Smith Health Research BC; Abortion Care Canada (St. Jacobs, ON); The Society of Obstetricians and Gynaecologists of Canada, Ottawa

<html> <body> <p> <strong>Mifepristone Implementation Research in Canada</strong> <br> <strong>(The CART-Mife Study)</strong> <br> <br> <strong>Introduction:</strong> Although the gold standard for medical abortion care worldwide has been use of mifepristone since the late 1990&rsquo;s, this medication was only recently approved in Canada (July 2015) with availability for use anticipated in 2016. At the current time access to abortion care in Canada is effectively limited to a small number (&lt;100) surgical facilities, primarily located in the largest urban centers. Fewer than four percent of all abortions are undertaken as medical abortion, in contrast to access in other developed countries where mifepristone facilitates safe, early, closer-to-home non-surgical care for 40% to 80% of all abortions.</p> <p>The introduction of mifepristone in Canada presents an exceptional opportunity to better understand the effectiveness of health care provider training on adoption of medical abortion into practice, in particular into the privacy, safety and confidentiality of a primary care office visit, and the impact on access to abortion, particularly for Canadian women in rural and remote areas.</p> <p> <strong>Research Question:</strong>What are the facilitators and barriers for successful initiation and ongoing provision for medical abortion service among health professionals undertaking mifepristone training, and how do these relate to access to abortion services throughout Canada?</p> <p> <strong>Research Objectives:</strong> <br> </p> <ol> <li>To understand health policy, system and service facilitators and barriers to the distribution and implementation of mifepristone abortion practice.</li> <li>To assess the impact of a &ldquo;Community of Practice&rdquo; platform to detect and support clinical, health service, and system challenges faced by clinicians adopting mifepristone medical abortion practice.</li> <li>To evaluate continuous integrated knowledge translation with health policy, health system and health services decision makers and health professional organizations to reduce barriers, and optimize facilitators, for mifepristone abortion practice.</li> </ol> <p> <strong>Methods: &nbsp;</strong>Observational prospective mixed methods study offered to mifepristone health professional certificants, enrolling up to 1500 within the first year, and engaging a sample of relevant stakeholders.</p> <p> <em>Primary outcome:</em> Proportion of trainees that are providing mifepristone one year post training.</p> <p> <em>Secondary outcomes:</em> &nbsp;reported barriers and facilitators and solution strategies supporting implementation of service provision; the proportion of trainees providing mifepristone at 6 months post training; the location and volume of service provision at one year.</p> <p>Primary and follow up quantitative information will be obtained by surveys, developed to address all components of Roger&rsquo;s Diffusion of Innovation theoretical framework, and for health professional adoption of practice will be addressed using socio-cognitive theory to assess the impact of continuing professional development on clinical behaviour intention, as developed by Legar&eacute;. A facilitated Community of Practice support platform will be established for participants. Qualitative interviews will be employed at 3 and 12 months post training to capture the range of factors influencing outcomes.</p> <p> <strong>Team:</strong> Our well established national CART-GRAC.ca network<br> <br> <strong>Impact:</strong> This foundational research at the time of introduction for an innovative practice in Canada, will support advances for &nbsp;training programs and will inform health policy, system and service improvements to facilitate equitable access to medication abortion options for women throughout Canada.</p> </body> </html>