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RESEARCH INTEGRATED WITH POLICY MAKERS:Real-time health policy and service improvements during
Mifepristone Implementation Research C a n a d aWENDY V. NORMAN, MD, MHScCANADA’S CHAIR, FAMILY PLANNING PUBLIC HEALTH RESEARCH; ASSOCIATE PROFESSOR, DEPT OF FAMILY PRACTICE, UNIVERSITY OF BRITISH COLUMBIA, VANCOUVER, CANADA
CANADA’S CONTRACEPTION & ABORTION RESEARCH TEAM, WWW.CART-GRAC.UBC.CA
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D IS C L O S U R E S
T h i s s t u d y i s f u n d e d b y g o v e r n m e n t a n d
n o n - p r o f i t f o u n d a t i o n s .
N o r m a n i s f u n d e d b y G o v e r n m e n t a s C a n a d a ’ s
F a m i l y P l a n n i n g P u b l i c H e a l t h R e s e a r c h C h a i r
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M IF E P R IS T O N E R E G U L A T IO NIN C A N A D A (INITIAL APPROVAL CONDITIONS):
• Prescribers must register with the manufacturer• Prescribers must be physicians• Prescribers must dispense directly to patients• Prescribers must observe patient swallowing mifepristone
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M IF E P R IS T O N E IM P L E M E N T A T IO N R E S E A R C H IN C A N A D A
A im : To improve equitable access to abortion by supporting provision of mifepristone in primary care
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M IFE STUDY OBJECTIVES 2 0 1 6 J u l – 2 0 1 9 J u n
1. To understand health policy, system , services and clinical facilitators and barriers to the
im plem entation and diffusion in Canada of m edical abortion care using m ifepristone
2. To assess the im pact of a “Com m unity of Practice” platform to detect and support clinical,
health service, and system challenges faced by clinicians adopting m ifepristone m edical
abortion practice
3. To collaborate with health policy, health system and health services decision m akers and
health professional organizations to address barriers, and im plem ent facilitators, of accessible
m ifepristone m edical abortion care.
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7
BC
ON
QC
NS
KU
KUKU
KUKU
8
C o n t in u o u s iKT:
Integrated Knowledge Translation
Evaluation of iKT & of Health Policy, System & Service
improvements
Interviews
Community of Practice
Surveys
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M E T H O D O L O G Y
National mixed methods study
C o n cep tu a l Fram ew o rksG re e n h a lg h ’s m o d e l:
• d if f u s io n o f in n o v a t io n s in h e a lt h s e r v ic e o rg a n iz a t io n s
G o d in ’s f ra m e
• h e a lt h c a re p ro v id e r a d o p t io n o f in n o v a t io n 10
11From G od in G , B e langer G rave l A , E cc les M , G rim shaw J. H ea lthcare p ro fess iona ls in ten tions
and behaviours: a system atic rev iew o f s tud ies based on soc ia l cogn itive theory12
R ESU LTS
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Over 800 physicians and pharmacists have completed a survey on their mifepristone practice.
277 physicians254 pharmacists
48 facility staff48 nurse practitioners35 Midwiveshave joined the CAPS community.
8% of physicians work in communities with no prior abortion service.
39% of physicians had never provided abortions before.
The majority of mifepristone providers are currently practicing in Primary care
settings
MIFEPRISTONE IN CANADAWho is providing abortions and where?
The Canadian Abortion Providers Support (CAPS-CPCA) website is an online community of practice for practitioners and pharmacists that provide mifepristone. Jan 2017 to Jan 2018
0 10 0 20 0 30 0
No
Ye s
H ave yo u p revio u sly
p ro vid ed
ab o rtio n serv ices?
M edi cal Su rgi cal Bo th Ne ith er
115 interviews with providers, non-providers, policy makers and stakeholders 14
M IF E P R IS T O N E R E G U L A T IO NIN C A N A D A : REVISION NOV 2017
• Prescribers must register with the manufacturer• Prescribers must be physicians• Prescribers must dispense directly to patients• Prescribers must observe patient swallowing mifepristone
MIFEPRISTONE IN CANADAWhere are we now?
Mifepristone became available in Canada in January 2017 Significant changes to federal and provincial policy by November 2017 include:
PharmacistsAre permitted to dispense Mifepristone
Universal coverage of mifepristone is available in most provinces:
Stock is distributed through usual pharmacy suppliers
New Brunswick, Alberta, Ontario, Nova Scotia, Quebec, and British Columbia, and all Federal Services
Nurse practitionersmay prescribe Mifepristone in 6 Provinces(Alberta, Nunavut, Ontario, Yukon, British Columbia, Nova Scotia)
Prescriber/dispenser personal information cannot be shared with the company that manufactures mifepristone
Health care professionals are Not required to witness
Training is no longer required to prescribe or to order, or to dispense mifepristone
a woman when she takes medical abortion pills. and,No consent form is required
Survey EnrollmentJan 15, 2017 to Mar 15, 2018
Distribution of Survey Respondents
18 Community of Practice
Join Canada’s online community for health professionals certified to provide Mifepristone. • Exchange tips, resources, and
best practices • Gain feedback from experts • Locate pharmacies in your
region
www.caps-cpca.ubc.ca
LEARN MORE
Credit: Shutterstock Version 2 | August 29, 2016
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Community of Practice EnrollmentJan 31, 2017 to Feb 28, 2018
Total
Mem
bers
W ho supplies/pays for M ifegym iso in your province?
Helpful Resources àCanadian Resources
Find a Pharm acy that stocks mife!
Ask an Expert
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E-Newsletter: receive updates on policy & regulation changes, coverage, training, resources,
etc.
26 Interviews
Physicians prescribing mife
Pharmacists dispensing mife
Policy and practice stakeholders
MDs and Pharmacist not intending to practice with mifepristone
C o n t in u o u s In te g ra te d K n o w le d g e T ra n s la t io n
HealthCanada
Quarterly face-to-face
Meetings
Monthly VC
HealthProfessionalRegulators
& Associations
GovernmentsHealth
Practitioners
Federal Health Minister invites CART Evidence Briefs
M ife p r is to n e P h a r m a c is t s c o m p le t in g C A P S s u r v e y , J u n e 2 0 1 7
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M ife p r is to n e P h y s ic ia n s c o m p le t in g C A P S s u r v e y s :
J u n e 2 0 1 7
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W O R K I N G W I T H P O L I C Y M A K E R S :
Tremendous enthusiasm among HCPs, professional organizations, policy-makers, government to support mifepristone abortion practice• Timing is everything• Communicationwith policy makers: regular, responsive• Willingness to change/adapt• Media can be helpful
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P R O JE C T T E A M
L e a d In v e s t ig a to r : W e n d y N o r m a n U B C K U L e a d : Ta m il K e n d a ll , B C M O H
Co-investigators
Rollin Brant (UBC)Stirling Bryan (UBC)Sheila Dunn (UofT)
Janusz Kaczorowski (UMontreal)Stroulia Eleni (U of A)
Judith Soon (UBC)
Junior Investigators
Melissa Brooks (DalhousieU)Dustin Costescu (McMasterU)Regina Renner (UBC)
Ashley Waddington (QueensU)Marie-Soleil Wagner (UMontreal)
Sarah Munro (UBC)
Knowledge Users
Supriya Sharma (Health Canada)Jennifer Blake (SOGC)Cheryl Davies/Dorothy Shaw (BC Women’s H)
Philip Emberley (Can Pharm Assn)Edith Guilbert (INSPQ)
James Meuser (CFPC)Jossette Rousell (Can Nurses Assoc)
wendy.norman@ubc.caCanada
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