SRFP067: “Meeting patients where they are”: attitudes of clinicians and staff on a mifepristone learning collaborative in primary care
Meera Sakthivel; Debra Stulberg, MD; Elizabeth Janiak, ScD; Ashley McHugh; Hillary Wolff, BS
Abstract
Context: Mifepristone, an antiprogestogen used in miscarriage management and abortion, is rarely prescribed in primary care settings in the U.S. Many barriers contribute to this gap. For example, mifepristone is regulated by the FDA’s restrictive Risk Evaluation and Mitigation Strategy, which was designed to regulate drugs with special safety risks, though mifepristone has a well-established safety profile. This policy requires patients to pick up mifepristone directly from clinics and forces prescribers to register as certified providers, creating logistical issues and exacerbating stigma. To prepare primary care clinics to provide mifepristone, the Excellence in Providing Access to New Directions in Mifepristone Use (ExPAND Mifepristone) learning collaborative was launched. Objective: Understand clinician and staff perspectives on the ExPAND Mifepristone learning collaborative at two participating federally qualified health centers (FQHCs). Study Design: Semi-structured interviews with a planned total of 20 clinicians and staff members at participating clinics. After verification, transcripts are coded for major themes using qualitative analysis software. Setting: Two Chicago FQHCs that did not previously provide mifepristone. All clinicians and staff at participating clinics are eligible. Key contacts at each clinic provided a list of possible participants who were contacted through email. Intervention: Clinics were trained in ordering and stocking mifepristone, billing and scheduling workflows, and preparing clinicians to prescribe mifepristone. Outcome Measures: Knowledge of mifepristone, perspectives on its use in primary care, perceived problems in the implementation of ExPAND Mifepristone, and possible improvements. Results: In the 9 interviews conducted so far, participants strongly support the provision of mifepristone for miscarriage management and express that ExPAND Mifepristone aligns with their clinics’ values. However, participants also report not having enough training for providers to yet feel comfortable prescribing mifepristone, as well as some communication difficulties. At this point, neither clinic plans to provide mifepristone for abortion care, and many participants had legal concerns around FQHC funding and abortions. Conclusions: Findings will inform future design of the learning collaborative to hopefully assist other primary care and community-based clinics in implementing evidence-based use of mifepristone.