Did you know you can now log your CPD with a click of a button? Providing medical abortion in general practice: General practitioner insights and tips for future providers. Background and objectives Medical abortion is safe and effective and, when provided by general practitioners GPs , can increase access for women. Methods Semi-structured telephone interviews were conducted with GPs providing medical abortion nationwide. Results Twenty-five GPs used three medical abortion models in private practice: common, streamlined and ultrasonography-inclusive.
Discussion Using three appointments for delivering medical abortion may be less acceptable and accessible to women than streamlined or ultrasonography-inclusive models. Methods A qualitative descriptive approach was taken to describe medical abortion models of care used by current GP providers within the general practice setting.
Recruitment and consent Recruitment followed purposive sampling and snowballing because of the low numbers of current GP medical abortion providers. Data collection Demographic details collected included the state and remoteness of medical abortion provision, length of time the GP has provided medical abortion in general practice, age, sex and practice s billing type. Data analysis Interviews were transcribed verbatim and corrected by SD.
Results Twenty-five participants from 24 practices were interviewed Table 1. Table 1. Model 1: Common The common model Figure 1A , used by 17 participants, involved either two or three appointments, dependent on whether appropriate investigations had been obtained prior to or at the first appointment.
Model 2: Streamlined Streamlined models Figure 1B had two appointments maximum. Model 3: Ultrasonography-inclusive Four participants from four different clinics used this model, performing ultrasonography themselves in-clinic Figure 1C.
General practitioner insights into establishing a medical abortion service Communicating initiation of delivering medical abortion Many participants were deliberate in communicating medical abortion initiation to their workplace to seek support from employers or to notify clinic staff of this new service. Participant [P] 18 Many participants who had communicated their decision to commence medical abortion delivery in their practice simultaneously restricted advertising of the service. Efficiency was also increased by participants establishing a relationship with local radiology: [B]y having a relationship with the radiographer Medical abortion provider community All participants spoke of the support they received from networks comprising other medical abortion providers.
P17 However, one participant queried the actual benefit of a group that is not easily accessible. Additional considerations for medical abortion delivery Use of anti-D Sourcing anti-D was perceived as difficult, especially when initiating medical abortion provision. P14 Follow-up considerations Methods of follow-up included in-person consultations, consultations with another GP or follow-up via telephone.
P19 When patients did not return for follow-up, several participants attempted contact through text messages, telephone calls and registered post. Cost and time of provision Few participants provided medical abortion via bulk billing, with most charging fees. P5 However, one participant had an increased income, while others perceived no change to income, as medical abortion provision fitted into their pre-existing appointment schedule. Relationship building with patients Most participants perceived their medical abortion service was acceptable to patients, although some had not received formal feedback.
P22, regional provider Three participants had dissatisfied patients. Conclusion This study focused on three models for delivering medical abortion currently used by GP medical abortion providers: common, streamlined and ultrasonography-inclusive. Implications for general practice Medical abortion models of care that limit the number of consultations required in general practice are feasible and guideline concordant. GPs wishing to commence medical abortion delivery are advised to consider establishing a network of supportive health professionals to facilitate medical abortion delivery, communicating to colleagues in their workplace their intent to provide the service, advertising the service to their patients and forming or joining a network of current providers for support, education and advice.
The creation of a more accessible CoP supported by government and endorsed by discipline peak bodies may improve the safety and effectiveness of medical abortion, and provide support for future and current GP medical abortion providers.
Provenance and peer review: Commissioned, externally peer reviewed. Acknowledgements The authors wish to express their thanks to the 25 participants of this study who shared their views and experiences of general practice medical abortion delivery.
Finally, they would like to express their gratitude to the Department of General Practice research team at Monash University for their support and feedback throughout the project. Create Quick log. Barriers around access to abortion experienced by rural women in New South Wales, Australia. Rural Remote Health ;16 1 Access, equity and costs of induced abortion services in Australia: A cross-sectional study.
A direct-to-patient telemedicine abortion service in Australia: Retrospective analysis of the first 18 months. Patient experiences in Australia: Summary of findings, — Canberra: ABS, Available at www. General practice activity in Australia — General practice series no.
Sydney: Sydney University Press, J Womens Health Larchmt ;19 3 — Australian abortion law and practice. Snapshot of medication abortion provision in the primary health care setting of regional and rural Victoria. Aust J Rural Health ;27 5 Postgraduate experiences with an advanced reproductive health and abortion training and leadership program. Fam Med ;49 9 — A long-term evaluation of a required reproductive health training rotation with opt-out provisions for family medicine residents.
Bleeding is usually heavier than a period and there may be large clots. Pain and cramping are generally much stronger than period pain.
After 2 — 6 hours the bleeding usually settles to the level of a normal period and continues like that of a normal period for another 3 — 7 days. A small number of people may experience unpredictable, irregular or prolonged bleeding that can last for up to 5 weeks.
General anaesthetic: a medicine used to make you unconscious. This is usually applied during surgery so you are not aware and unable to feel the pain. Abortion service providers are located across Victoria in a range of health services and private practices. The costs, procedures and time required can vary from service to service.
Having an abortion earlier in a pregnancy can minimise procedure costs and maximise your options. To find surgical or medical abortion services in Victoria contact My Options phone line If you have a booking for a medical abortion at Family Planning Victoria, please refer to our Client Information Medication Abortion information sheet.
If you are using the internet for information, only use reliable and reputable websites, such as the ones provided above. Be aware of anti-abortion or pro-life websites containing inaccurate and harmful information and imagery. Close menu Close. Search Search. The main points Medical abortion offers a safe and common method to end a pregnancy of up to 9 weeks.
The U. Food and Drug Administration approved mifepristone to be used in combination with a second drug, misoprostol, to end an early pregnancy or manage a miscarriage. Chuang rejected their request last month. ACLU lawyers represent the groups. Government lawyers have argued that the requirements are necessary to ensure that patients safely use mifepristone. Use the link below to request membership.
The Moderator will send a Facebook message and if a copy of your training certificate can be provided, the request will be approved. If there is not already a registered pharmacy in you area which stocks and dispenses MS 2-Step you will need to enlist one, as GP MTOP providers need to be affiliated with a specific dispensing pharmacy.
You can access information about registered pharmacies through the MS 2-Step site once you are a certified prescriber. This is a simple administrative step for the pharmacy. Some GP providers have found it helpful to establish a timely process for requesting investigations when the woman calls to book for an MTOP.
Your reception and nursing staff may play a key role in supporting this process. To ensure timely provision of MTOP to your patients some GPs have enlisted the support of local medical imaging groups. The referral for USS should be identified as a dating scan.
Some practitioners have established further notation on the referral form to allow the sonographer to know when the dating scan is for the purposes of a MTOP. This supports the sonographer to provide a service sensitive to the woman, for example, asking whether or not the woman would like to see the image and if she would like the sound turned on or off, and can help reduce the time between GP appointments.
Some GP providers block out a set number of priority appointments each day or across a week to ensure MTOP patients can be booked in quickly for their consultations. The busyness of your practice and the level of demand for MTOP may be key drivers in whether your practice needs to make these arrangements.
In the rare event of a patient requiring presentation to the ED after her MTOP, any hospital should be able to respond to issues of vaginal bleeding or pain management as per the Queensland Health clinical guideline on early pregnancy loss ; some GPs have chosen at their discretion to inform the local hospital they intend to start providing an MTOP service, particularly in smaller communities.
Good practice is to ensure that your patient has a letter of referral to take with them to the emergency department should they develop adverse symptoms. We can assist you to develop a template referral letter for you patients. Many providers do choose to advise their patients it is not required to show the letter at the hospital, should they develop symptoms. Patients have identified many reasons for not choosing to disclose their abortion, including but not limited to concerns regarding being judged by staff at the hospital or if their social situation leaves them at risk of violence in the home.
You will have been advised by MSHealth that your patients can access their 24 hour after care number that is staffed by nurses Our Children by Choice counselling line, staffed Monday to Friday 9am to 5pm can also offer Queensland women post abortion counselling if necessary. Copies of our small post-abortion brochure with information and contact details can be sent to your practice free of charge.
Below are two of many models for incorporating MTOP into the flow of your general practice.
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