SP13-96: Dispensing Mifepristone for First-Trimester Medical Abortion in Canada: Survey Results of Pharmacists Perspectives
University of British Columbia Canada
to identify and address the facilitators and barriers for successful initiation and ongoing provision of medical abortion service among health care professionals who have mifepristone certification, and how these relate to the distribution and availability of services throughout Canada.
We surveyed pharmacists from various practice settings across Canada and assessed barriers and facilitators for implementation of mifepristone dispensing in community pharmacies. We also assessed pharmacist knowledge, perspective and experience with mifepristone use and needs of the community.
We collected results from 566 pharmacists. Of them, 541 (93.3%) worked in a community pharmacy and 493 (87.1%) are currently dispensing medications. Men comprised 30.4% of our cohort and 51.1% of our cohort practice in a rural setting. The mean (SD) age was 41.1 (11.2) years.
Key facilitators for dispensing mifepristone were privacy (391 participants, 91.2%) and accessibility (390 participants, 91.9%). Regarding privacy, 383 participants (88.3%) indicated that they have private counseling area in their pharmacy and 397 (91.4%) indicated they feel comfortable counseling patients privately in their current setting. Regarding accessibility, 372 (89.8%) indicated that they believe mifepristone dispensing by a pharmacist is important and 278 (67.3%) indicated that mifepristone dispensing fits into the pharmacy’s activities.
While 418 (95.4%) participants indicated that they are willing to dispense mifepristone, 20 participants (3.5%) indicated that they are not willing to dispense it. Years since graduation and years worked as a community pharmacist were found to be associated with unwillingness to dispense mifepristone (chi2, p): 63.9, 0.041 and 80.8, 0.001, respectively. Completing a hospital residency was associated with mifepristone dispensing (4.1, 0.043). We found that the following factors were not associated with unwillingness to dispense mifepristone (chi2, p): age (38.5, 0.743), sex (0.17, 0.916), living setting (80.8, 0.733), pharmacy management (0.93, 0.34) or ownership status (1.37, 0.242).
Reported barriers with mifepristone dispensing included cost (33.3%) of the medication (each dose is estimated at $300), liability (19.4%), lack of prescribers (18.1%), inadequate stock (17.2%), lack of training (17.0%), lack of pharmacy staff (13.3%), lack of private counselling areas (13.1%), short shelf life (11.9%), resistance from public (6.6%), resistance from management (6.3%), resistance from the healthcare team (5.1%), resistance from the pharmacy team (4.9
In Canada, despite the availability of mifepristone, surgery is still the most common form of pregnancy termination. Different rates of mifepristone use have been reported around the world, comprising 10% of pregnancy termination procedures in the United States and 4% in Canada, compared with up to 80% in Europe. With 96% of pregnancy termination procedures carried out via surgery in Canada, women are often required to travel long distances to access a clinic to provide this essential healthcare service.
While access to a mifepristone prescriber is often limited in rural and remote locations, community pharmacies are often accessible to these populations. Our survey results suggest that community pharmacists are ready, trained, prepared and interested in dispensing mifepristone, and infrastructures are set in place for safe, private, non-judgmental access to the medication. Dispensing mifepristone in community pharmacies can reduce the inequality and disparities between urban and rural settings commonly seen in the Canadian healthcare system, by improving access to medical abortion medications, regardless of geographical location. With mifepristone dispensed at pharmacies, women in need of medical abortion can either access a physician through in-person visit, or when that is not a possibility, through remote services such as tele-medicine which can prescribe mifepristone that can then be dispensed close to home.
Pharmacists are the ideal healthcare professional to dispense mifepristone as they are highly trained drug experts who are accustomed to safely dispensing, educating, counselling and following-up with patients on medication use. Efforts should be made to provide patients with a private place for counselling. Barriers raised by pharmacists can be addressed through education, training and development of programs to assist with resistance and misinformation, and by government initiatives to cover drug costs.