Mifepristone implementation in primary care: Clinician and staff insights from a pilot learning collaborative.

OBJECTIVES: The ExPAND Mifepristone (ExPAND) learning collaborative aims to support primary care providers in overcoming logistical barriers to mifepristone provision. This qualitative study describes clinician and staff perspectives on the impact of ExPAND in two federally qualified health center networks (FQHCs). STUDY DESIGN: Researchers conducted semi-structured qualitative interview with a purposive sample of clinicians, staff, and leadership from two Illinois FQHCs. We analyzed transcripts in batches using modified grounded theory to identify themes regarding the reception of ExPAND and barriers to and facilitators of mifepristone implementation. RESULTS: Participants (n = 13) expressed strong support for providing mifepristone for miscarriage management at their clinics. Most also personally supported mifepristone for abortion care. Many participants felt that ExPAND reflected their clinics' values, as it strengthens the primary care relationship, emphasizes patient-centered care, and addresses disparities in access. Barriers to implementation included fear that providing abortion care would jeopardize FQHC funding and logistical hurdles due to the coronavirus disease pandemic. CONCLUSIONS: Participants felt that mifepristone provision in primary care was an important service, and that ExPAND helped achieve that goal. Future clinics participating in ExPAND would benefit from education about how FQHCs can provide mifepristone for abortion care while complying with federal funding restrictions. IMPLICATIONS: Learning collaboratives like ExPAND can prepare primary care clinics to provide mifepristone. Participants describe a clear benefit of mifepristone integration to their patients, and they report mifepristone integration aligns with clinic values.

Provision of abortion and other reproductive health services among former Midwest Access Project trainees.

OBJECTIVE: The Midwest Access Project (MAP) offers opt-in training to students, residents and practicing clinicians in reproductive health care including abortion. We surveyed MAP alumni to identify current practice characteristics and assess predictors of reproductive health service provision. STUDY DESIGN: We sent an online survey to alumni of MAP's Individual Clinical Training program, 2007-2015 (n=127). The primary outcome was current provision of any abortion service. Secondary outcomes included providing specific abortion services and other reproductive services. RESULTS: We received responses from 61% of eligible MAP alumni (n=77 out of 127). The majority reported a specialty of Family Medicine (68%) and current location in the Midwest (52%). Among current residents, fellows or clinicians practicing in a field whose scope includes abortion (n=56), 50% provide abortion. Most (84%) provide outpatient miscarriage management, and nearly all (≥96%) provide pregnancy options counseling and full scope contraception. Respondents who received the most advanced training in medication abortion as part of their MAP training were more likely to report providing abortion in their current practice than those who did not (63% vs. 32%, p=.027), as were those who completed more than one MAP rotation compared to those who completed one rotation (100% vs. 44%, p=.009). CONCLUSIONS: Half of MAP's alumni provide some abortion care. Nearly all provide comprehensive counseling and contraceptive services. IMPLICATIONS: Opt-in training is a promising strategy to develop providers of comprehensive reproductive health care.