4 results on '"Fields, Alison"'
Search Results
2. Exploring the impact of mifepristone's risk evaluation and mitigation strategy (REMS) on the integration of medication abortion into US family medicine primary care clinics✰,✰✰.
- Author
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Razon, Na'amah, Wulf, Sarah, Perez, Citlali, McNeil, Sarah, Maldonado, Lisa, Fields, Alison Byrne, Carvajal, Diana, Logan, Rachel, and Dehlendorf, Christine
- Subjects
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ABORTION clinics , *FAMILY medicine , *ABORTION , *MIFEPRISTONE , *PRIMARY care , *RISK assessment , *MISCARRIAGE , *PRIMARY health care , *RESEARCH funding - Abstract
Objectives: In 2000, the United States' Food and Drug Administration (FDA) approved mifepristone for medication abortion. In this article, we explore how the Risk Evaluation and Mitigation Strategy (REMS) criteria for mifepristone specifically impede family physicians' ability to provide medication abortion in primary care settings.Study Design: We conducted 56 qualitative interviews with a national sample of family physicians across the US who were not opposed to abortion. We examined how the REMS criteria for mifepristone impact family physicians' ability to provide medication abortion.Results: Of the 56 interviews conducted, 23 participants (41%) raised the REMS criteria as a barrier to providing medication abortion in primary care. These participants reported the REMS added a layer of bureaucratic complexity that made it difficult for family physicians to navigate, even when trained, to provide abortion care. These family physicians described 2 predominant ways the REMS impede their ability to provide medication abortion: (1) The REMS require substantial involvement of clinic administration, who can be unsupportive; (2) The complexity of navigating the REMS results in physicians and clinic administration in primary care viewing medication abortion as not worth the effort, since it is only a small component of services offered in primary care.Conclusion: Removing the REMS could simplify integration of medication abortion into primary care, which could meet patient preferences, improve access, and reduce abortion stigma. The FDA's revised REMS criteria may ease administrative burden but will likely maintain key barriers to integrating medication abortion into family physicians' practice.Implications: Our study highlights that the REMS criteria are barriers to family physicians' ability to integrate medication abortion into their primary care practices. The FDA's removal of in person dispensing criteria may provide some impetus for trained family physicians to integrate medication abortion into their scope of practice but the revised REMS criteria maintain key barriers to broader adoption. [ABSTRACT FROM AUTHOR]- Published
- 2022
- Full Text
- View/download PDF
3. "They Go Hand in Hand": Perspectives on the Relationship Between the Core Values of Family Medicine and Abortion Provision Among Family Physicians Who Do Not Oppose Abortion.
- Author
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Wulf S, Carvajal DN, Razon N, Perez C, McNeil S, Maldonado L, Fields AB, Silverstein I, and Dehlendorf C
- Subjects
- Pregnancy, Female, Humans, United States, Physicians, Family, Family Practice, Abortion, Induced
- Abstract
Introduction: Most family physicians do not provide abortion care, despite an apparent alignment between the defined values of family medicine and provision of abortion in primary care. This study seeks to understand how family physicians themselves perceive the relationship between their specialty's values and abortion provision., Methods: We conducted in-depth interviews in 2019 with 56 family physicians who do not oppose abortion in the United States. We employed a deductive-inductive content analysis approach with memos to identify key themes. This analysis focuses on participants' beliefs in the core values of family medicine and how those values relate to abortion in family medicine., Results: Participants identified and described six values of the specialty they prioritized, which included relationships, care across the lifespan, whole-person care, nonjudgmental care, meeting community needs, and social justice. Family physicians in the study overwhelmingly believed that abortion aligned with family medicine values, regardless of whether they themselves provided abortion care., Conclusions: Providing abortion care in primary care settings gives family physicians an opportunity to provide comprehensive care while improving access to meet community needs. As abortion care becomes increasingly restricted in the United States, family physicians can manifest the values of family medicine through integrating abortion care into their practices in states where abortion remains legal., Competing Interests: Conflict of interest: None., (© Copyright by the American Board of Family Medicine.)
- Published
- 2023
- Full Text
- View/download PDF
4. Family Physicians' Barriers and Facilitators in Incorporating Medication Abortion.
- Author
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Razon N, Wulf S, Perez C, McNeil S, Maldonado L, Fields AB, Holt K, Fox E, Silverstein I, and Dehlendorf C
- Subjects
- Female, Humans, Physicians, Family, Pregnancy, Qualitative Research, United States, Abortion, Induced, Internship and Residency
- Abstract
Purpose: Medication abortion (MAB) provision by family physicians has the potential to expand abortion access. However, there are documented individual and structural barriers to provision. This study investigates how family physicians in the United States (US) navigate the barriers impeding abortion provision in primary care., Methods: We conducted a qualitative study on the experiences of US family physicians with MAB in primary care. We recruited participants at national conferences and via professional networks. This analysis focuses on the experiences of the subset of participants who expressed interest in providing MAB., Results: Forty-eight participants met inclusion criteria, with representation from all 4 regions of the US. Participants had diverse experiences related to abortion provision, training, and the environment in which they practice, with a third of participants working in states with hostile abortion policies. We categorized participants into 3 groups: (1) doctors who did not receive training and do not provide abortions (n = 11), (2) doctors who received training but do not provide abortions (n = 20), and (3) doctors who received training and currently provide abortions (n = 17). We found that training, administrative and community support, and internal motivation to overcome barriers help family physicians integrate MAB in primary care practices. Federal and state laws, absence of training, stigma around abortion provision, inaccurate or limited knowledge of institutional barriers, and administrative resistance all contributed to doctors excluding abortion provision from their scope of practice., Conclusion: Improving medication abortion provision by family physicians requires addressing the individual and system barriers family physicians encounter so they receive the education, training, and support to successfully integrate abortion care into clinical practice., Competing Interests: Conflicting and Competing interests: None declared., (© Copyright 2022 by the American Board of Family Medicine.)
- Published
- 2022
- Full Text
- View/download PDF
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