Barriers and Enablers to Family Physicians' Provision of Early Pregnancy Loss Management in the United States.

Autor: deFiebre G; Reproductive Health Access Project, New York, New York; CUNY Graduate School of Public Health and Health Policy, New York, New York. Electronic address: gabrielle.defiebre01@sphmail.cuny.edu., Srinivasulu S; Reproductive Health Access Project, New York, New York., Maldonado L; Reproductive Health Access Project, New York, New York., Romero D; CUNY Graduate School of Public Health and Health Policy, New York, New York., Prine L; Reproductive Health Access Project, New York, New York; Institute for Family Health, New York, New York., Rubin SE; Institute for Family Health, New York, New York.
Jazyk: angličtina
Zdroj: Women's health issues : official publication of the Jacobs Institute of Women's Health [Womens Health Issues] 2021 Jan-Feb; Vol. 31 (1), pp. 57-64. Date of Electronic Publication: 2020 Sep 24.
DOI: 10.1016/j.whi.2020.07.003
Abstrakt: Background: Early pregnancy loss (EPL) is a common experience. Treatment options include expectant management, medication, and uterine aspiration. Although family physicians can offer comprehensive EPL treatment in their office-based settings, few actually do. This study explored the postresidency provision of EPL management and factors that inhibit or enable providing this care among family physicians trained in early abortion during residency.
Methods: Using an exploratory sequential mixed-methods design, we studied a sample of family physicians trained in early abortion during residency. We initially interviewed a subset trained in uterine aspiration during residency, then surveyed the entire sample. Interview transcripts were coded and analyzed using grounded theory; results informed survey development. On survey responses, we used Pearson χ 2 to examine the association between certain variables and provision of EPL care options.
Results: Most of the 15 interview and 231 survey respondents provided expectant management of EPL. Of the survey respondents, 47.2% provided medication management and 11.4% manual vacuum aspiration. Key challenges and facilitators involved referral, training, ultrasound access, and managing systems-level issues. In bivariate analyses, providing prenatal care, offering abortion care, access to ultrasound, and competency were positively associated with providing EPL management options (p < .05).
Conclusions: Clinical training alone is insufficient to expand access to comprehensive EPL care in family medicine office-based settings. Supporting family physicians during and after residency with training and technical assistance to address barriers to care may strengthen their abilities to champion practice change and expand access to comprehensive EPL management options.
(Copyright © 2020 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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