The Use of Academic Detailing to Bring Medication Abortion to California's Rural Primary Care Providers.

Each year in the United States, over one million unintended pregnancies end in abortion. Although women's need for abortion care is high, access to such care has become more difficult, in part due to the concentration of care within specialty abortion clinics. The number of private physicians who provide abortion care has declined precipitously as has the number of abortions performed in hospitals. In September 2000, the FDA approved mifepristone (known as RU486 in France and commonly called the "abortion pill") for distribution and use. Proponents of medication abortion availability heralded mifepristone's potential to reverse the decline in abortion access, as it can be used by health providers with minimal special training or equipment. This paper discusses the results of a project using a provider education approach known as academic detailing to facilitate the diffusion of medication abortion among primary care physicians in rural California. This study found relatively low knowledge and provision of mifepristone but identified widespread support for abortion generally and surprising changes in physicians' willingness to provide medication abortion among those that received academic detailing. These providers identified the resources that would make them more likely to provide mifepristone. The majority of those physicians who received academic detailing visits found the information and the visits useful. These results suggest that academic detailing may be one way to increase awareness of and potential use of mifepristone for medication abortion. Implications for the study of abortion provision specifically and medical sociology of technological diffusion more broadly are provided. ..PAT.-Unpublished Manuscript [ABSTRACT FROM AUTHOR]