Barriers and Enablers to Family Physicians’ Provision of Early Pregnancy Loss Management in the United States
| Autor: | Linda Prine, Susan E. Rubin, Silpa Srinivasulu, Gabrielle deFiebre, Lisa Maldonado, Diana Romero |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
Health (social science) Referral medicine.medical_treatment Early Pregnancy Loss Prenatal care Abortion Grounded theory 03 medical and health sciences 0302 clinical medicine Pregnancy Maternity and Midwifery medicine Early abortion Humans 030212 general & internal medicine Practice Patterns Physicians' Vacuum aspiration 030219 obstetrics & reproductive medicine business.industry Public Health Environmental and Occupational Health Physicians Family Obstetrics and Gynecology Treatment options Abortion Induced United States Abortion Spontaneous Family medicine Female Family Practice business |
| Zdroj: | Women's Health Issues. 31:57-64 |
| ISSN: | 1049-3867 |
| DOI: | 10.1016/j.whi.2020.07.003 |
| Popis: | 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 χ2 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 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. |
| Databáze: | OpenAIRE |
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