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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

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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