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Development and implementation of a prescriber checklist and reference guide for mifepristone medication abortion

Background:

In 2017, mifepristone medical abortion was introduced in Canada. To support uptake of this gold-standard practice into primary care, we developed and implemented a charting checklist and quick reference guide to support health care providers to offer medial abortion care. 

Methods:

The preliminary checklist and reference guide were adapted from 7 clinical exemplars using the 2016 Society of Obstetricians and Gynaecologists of Canada guidelines on medical abortion. Materials were subjected to expert review (n=6). Front-line providers (n=5) gave feedback on the revised materials in ‘think-aloud’ interviews and rated the materials using the System Usability Scale (SUS). Final materials were approved by expert reviewers; English and French versions were shared with providers through communities of practice convened online and in person. 

Results:

Expert reviewers were 4 clinician-researchers, 1 community stakeholder, and 1 knowledge translation scientist. Front-line participants were 2 family physicians, 1 obstetrician-gynaecologist, 1 family medicine resident, and 1 registered nurse. Front-line participants had between 2 and 20+ years in practice; 3 had previous experience with medication abortion and 2 did not. Changes to the materials focused on alignment with clinical guidelines and best practices as well as suitability for the clinical context. The median SUS was 86.25 (69.4-97.5), indicating good-to-excellent usability, Between April 2018 and October 2021, the resources were downloaded 5,704 times, including a marked increase in downloads following the outbreak of the COVID-19 pandemic. 

Conclusions:

Many Canadian health care providers are adding medication abortion to their scope of practice for the first time. The tools described above are supporting the implementation of medical abortion services in the Canadian context. 

Kate Wahl Checklist poster

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