Medical Abortion: Outcomes in a Family Medicine Setting

The Journal of the American Board of Family Medicine

Caitlin Shannon¹  William A. Crowden²  Linda Prine⁵  Jennifer Fortin⁴  Ilana Dzuba¹  Ginger Gillespie⁵  Michelle Howe³ 

[1]Gynuity Health Projects (CS, ID), New York, NY

[2]Planned Parenthood of Waco, TX (WAC)

[3]Family Planning Associates Medical Group, Chicago, IL (MH)

[4]Planned Parenthood League of Massachusetts, Boston (JF)

[5]Institute for Family Health (LP, GG), New York, NY

关键词: Practice-based Research;    PBRN;    Abortion;    Misoprostol;    Family Medicine;   

DOI  :  10.3122/jabfm.2010.04.090229

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: To compare outcomes of early medical abortion with mifepristone and misoprostol in a family medicine setting and specialized reproductive health clinics.

Methods: This study used data collected from a prospective, open-label, randomized trial of oral versus buccal misoprostol efficacy. A secondary analysis was performed, evaluating efficacy, acceptability, and interventions after medication at the family medicine site compared with the 6 specialized reproductive health sites.

Results: Comparing data from patients in the family medicine setting (n = 116) to specialized reproductive health sites (n = 731) revealed no difference in overall efficacy (95.7% vs 93.4%; P = .351). The family medicine site used a second dose of misoprostol more frequently than the other sites (6.9% vs 2.5%; P = .018). In addition, uterine aspiration after medical abortion at the family medicine site was not used for “medically necessary” reasons whereas reproductive health clinics used it 2.6% of the time (marginally significant; P = .094). Patient satisfaction at family medicine sites was comparable to the other sites (91.2% vs 92.0%; P = .792).

Conclusion: Medical abortion has similar efficacy and patient satisfaction when offered in a family medicine practice or at a reproductive health specialty clinic. These findings should reassure family physicians that medical abortion can be offered safely in their practices.

• Practice-based Research
• PBRN
• Abortion
• Misoprostol
• Family Medicine

The United States has a major shortage of physicians who provide abortions, and the number of providers continues to decline each year.¹ Despite the need for more providers, many barriers have prevented family physicians specifically from providing abortion services to their patients. Some liability insurance carriers have refused to cover family physicians for abortion procedures, although there is no reason to expect any change in risk when the medication is provided by a family physician.² In addition, health insurance companies have denied claims for reimbursement to family physicians.³ Finally, most family medicine residency training programs fail to include abortion care in the curriculum, and the Residency Review Committee does not address abortion skills for family medicine residents in its guidelines.⁴

Family medicine sites have been involved in medical abortion research in the United States since the outset and several published studies have demonstrated good outcomes for medical abortion performed in family medicine settings.^5–8 (In patient education materials, we used the wording “medication abortion” to make it clear to patients that the abortion is caused by a pill; however, the convention used in the medical literature has been to call it “medical abortion,” so to be consistent with the published literature we have used that term here.) No published studies have compared medical abortion outcomes in the family medicine setting versus outcomes in specialized reproductive health clinics. This study was conducted from September 2006 until August 2007 to examine the efficacy of buccal and oral administration of 800 μg misoprostol during the 63 days since the last menstrual period; the primary analysis on comparative efficacy has been published previously.⁹ Using a secondary data analysis, this article examines the outcomes and patient satisfaction of medical abortion performed in the family medicine setting compared with those performed at specialized reproductive health sites.

【 授权许可】

Unknown   

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