ABSTRACT
Objectives: In 2017, mifepristone became available for first trimester medical abortion (FTMA) in Canada. Shortly after, regulations permitted pharmacies to dispense mifepristone to patients, facilitating telemedicine provision. Our objective was to explore the barriers to providing FTMA using telemedicine in Canada in 2019. Methods: We conducted a cross-sectional, national, self-administered, anonymized survey of physicians and nurse practitioners who provided abortion care in Canada in 2019. Online invitations were sent through professional health organizations using a modified Dillman technique to optimize recruitment. Questions elicited provider demographics and perceived barriers to offering telemedicine FTMA. We used R software for descriptive statistics. Results: Four hundred sixty-five clinicians were included for analyses, of which 388 reported providing FTMA. Among those, 44.0% reported using telemedicine (for consultations, while often obtaining testing) for FTMA. British Columbia respondents reported the highest proportion of telemedicine use at 63.8%;the lowest was in Québec (10.7%). The majority of FTMA respondents (77.7%) reported barriers to telemedicine. The most common barriers were inability to confirm gestational age with ultrasound (43.0%), and lack of provincial fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Few reported facility regulations (8.9%) and provincial regulations (4.9%) as barriers to providing telemedicine-based care;provincial regulation barriers were most common in Québec (16.1%). Conclusions: Less than half of respondents reported providing some abortion care via telemedicine and the majority perceived barriers. Low-test medical abortion protocols developed during COVID-19 have the potential to overcome some barriers. Keywords: telemedicine;abortion, induced;surveys and questionnaires;Canada;delivery of health care;mifepristone
ABSTRACT
Objectives: Canada was positioned to transition to telemedicine abortion care during the COVID-19 pandemic because REMs-like mifepristone restrictions were removed previously. We sought to characterize the impact of the pandemic response on Canadian clinical practice and abortion care access from the provider perspective. Methods: This was a sequential mixed methods study conducted between July 2020 and January 2021. A national sample of abortion providers completed a survey containing an open-ended question about the impact of the pandemic response. We took an inductive thematic approach to analysis that informed a second, primarily quantitative, survey. Results: The first survey was completed by 307 participants and the second by 78. Overall, 85% were physicians, 6% were nurse practitioners, and the remainder were pharmacists or administrators. Our thematic analysis identified 3 topics: access to abortion care, which was usually maintained despite pandemic-related challenges (eg difficulty obtaining tests, reduced operating time, limited referral pathways, new costs);change of practice to low- and no-touch medication abortion care;and provider perceptions of the patient experience, including shifting demand, good telemedicine acceptability, and increased rural access. The second survey showed uptake of telemedicine medication abortion among 89% of participants outside the province of Québec, where uptake was 33%. Pandemic-related restrictions did not delay care according to 76% of participants. Conclusions: The pandemic led to a robust transition to telemedicine abortion care in most of Canada, facilitated by prior removal of mifepristone restrictions and consideration of abortion as essential. Our findings could inform innovation in medication abortion service delivery in the US setting.