How can we encourage the provision of early medical abortion in primary care? Results of a best–worst scaling survey.

Background: Almost one in four women in Australia experience an unintended pregnancy during their lifetime; of these, approximately 30% currently end in abortion. Although early medical abortion (EMA) up to 9 weeks gestation is becoming more widely available in Australia, it is still not commonly offered in primary care. The aim of this study was to investigate the barriers and facilitators to the provision of EMA in primary care. Methods: A sample of 150 general practitioners (GPs) and 150 registered nurses (RNs) working in Australia responded to a best–worst scaling survey designed to answer the following question: what are the most important facilitators and barriers to the provision of EMA in primary care? Results: GPs believe that the lack of clinical guidelines, the amount of information provision and counselling required, and the fact that women who are not their patients may not return for follow-up are the most important barriers. For RNs, these three barriers, together with the stigma of being known as being involved in the provision of EMA, are the most important barriers. The formation of a community of practice to support the provision of EMA was identified by both professions as the most important facilitator. Conclusions: Having access to a community of practice, enhanced training and reducing stigma will encourage the provision of EMA. Although clinical guidelines are available, they need to be effectively disseminated, implemented and endorsed by peak bodies. Primary care practices should consider using task sharing and developing patient resources to facilitate the provision of information and counselling. Although available, early medical abortion is not commonly offered in general practice. When asked, GPs and RNs reported that lack of clinical guidelines, the need to provide information and counselling, and follow-up issues were important barriers to the provision of early medical abortion, whereas having access to a community of practice was the most important facilitator. Guidelines are available, but require dissemination and implementation. Task sharing and appropriate remuneration will encourage more GPs to offer early medical abortion, so it is seen as an essential service. [ABSTRACT FROM AUTHOR]