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.
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Debra Stulberg
stulberg@uchicago.edu 11/20/2021

Great job, Meera! Poster viewers: If you know of primary care practices/clinics that are beginning to offer mifepristone for early pregnancy loss and/or medication abortion (or even considering it), we'd love to hear from you!

Jack Westfall
jwestfall@aafp.org 11/21/2021

Thanks for your terrific work on this research. Hope you can connect with us at the Robert Graham Center https://www.graham-center.org/rgc/home.html

Lauren Oshman
laoshman@med.umich.edu 11/22/2021

We have mifepristone now! (U of M primary care, not FQHC). I'm curious about our local FQHC Packard Health and will ask them. I still haven't used it yet, I think we will need ongoing support and education for our teams as I'm guessing it will be a rarer use medication. Our department champions did a GREAT job education everyone, getting forms signed, etc.

Diane Harper
harperdi@med.umich.edu 11/22/2021

it is often the staff in the office who need to meet the patient where she is.. Present your results in Phoenix next year! Thank you for sharing your work with NAPCRG!

William R. Phillips
wphllps@uw.edu 11/23/2021

Great poster on an important and timely clinical problem/opportunity. Research – like women's healthcare – is more difficult than it should be in the USA. One idea for a promising next step would be to identify clinics who have successfully organized to provide this service add to case studies to describe their strategies, procedures and success. Hope you continue on this important line of inquiry. Thanks for sharing your work here at NAPCRG. - Bill Phillips

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Great job on this important topic regarding access.

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