The Safety and Quality of Abortion Care in the United States (2018) / Chapter Skim
Currently Skimming:
3 Essential Clinical Competencies for Abortion Providers
3 Essential Clinical Competencies for Abortion Providers
Pages 95-128
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From page 95... ...
Thus, this chapter identifies the clinical competencies for providing abortion care safely and with the highest degree of quality, the types of providers with the clinical competence to perform abortions, current abortion training of physicians and advanced practice clinicians (APCs) , and the availability of appropriately trained clinicians.
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Ryan Residency Training Program, Fellowship in Family Planning, Reproductive Health Education in Family Medicine (RHEDI) , Reproductive Health Access Project, and others.
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See Table 3-1 for a list of all competencies by procedure type. Patient Preparation As noted in Chapter 2, patient preparation involves providing information to the patient about the available abortion methods (including pain TABLE 3-1 Required Competencies by Type of Abortion Procedure Type of Procedure Dilation and Medication Aspiration Evacuation Induction Competencies Abortion Abortion (D&E)
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Evaluation is necessary for developing a patientcentered clinical plan, determining the appropriate method and setting of abortion care, and knowing when to refer patients in need of more sophisticated clinical settings (Davis and Easterling, 2009; Goodman et al., 2016; RCOG, 2015)
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NAF and the UCSF Bixby Center recommend that providers have established protocols for medical emergencies, including bleeding and hemorrhage, perforation, respiratory arrest/depression, and anaphylaxis, and for emergency transfer (Goodman et al., 2016; NAF, 2017)
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Prescribing medication abortion is no different from prescribing other medications -- providers must be able to recognize who is clinically eligible; counsel the patient regarding medication risks, benefits, and side effects; and instruct the patient on how to take the medication correctly and when to seek follow-up or emergency care. Chapter 2 describes the U.S.
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. The essential competencies for all abortion procedures form the basis of the skill set required for aspiration abortion.
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The committee identified systematic reviews, randomized controlled trials, and a variety of cohort studies assessing the outcomes of abortions provided by family medicine physicians or comparing the outcomes of abortions performed by physicians and nurse practitioners (NPs) , certified nurse-midwives (CNMs)
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and 96 OB/GYN or family medicine physicians (n = 5,812)
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analyzed the outcomes of aspiration abortions provided by three PAs in a Vermont clinic (n = 546) and three physicians (n = 817)
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Family Medicine Physicians Multiple studies have concluded that family medicine physicians provide medication and aspiration abortions safely and effectively (Bennett et al., 2009; Paul et al., 2007; Prine et al., 2003, 2010) with a high degree of patient satisfaction (Paul et al., 2007; Prine et al., 2010; Summit et al., 2016; Wu et al., 2015)
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. Catholic and Catholic-owned health care institutions are the largest group of religiously owned nonprofit hospitals, governing 15 percent of all acute care hospitals and 17 percent of hospital beds in the United States, and in many areas, these institutions function as the sole community hospital.4 Employees at these institutions are bound by Ethical and Religious Directives for Catholic Health Care Services, which prohibits providing and teaching certain reproductive services, including abortion (Freedman and Stulberg, 2013; Freedman et al., 2008; Stulberg et al., 2016)
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From page 107... ...
A 2014 study of OB/GYN fourth-year residents associated with 161 of the 248 total residency programs found that 54 percent of residents reported routine abortion training; 30 percent reported opt-in training, where the training was available but not integrated; and 16 percent reported that training in elective abortion was unavailable in their program (Turk et al., 2014)
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. The program offers resources and technical expertise to OB/GYN departments that wish to establish a formal, opt-out rotation in family planning (Ryan Residency Training Program, 2017a)
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. Family Medicine Women's reproductive health care is a fundamental component of family medicine.
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reported currently practicing these procedures.7 Most family medicine programs do not offer specific training in abortion, and only a small proportion of family physicians report having had access to abortion training (Herbitter et al., 2011, 2013; Lesnewski et al., 2003; Steinauer et al., 1997; Talley and Bergus, 1996)
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. In addition to the RHEDI programs discussed below, seven family medicine residency programs offer integrated and comprehensive abortion training, and two programs offer established local electives in abortion training (RHEDI, 2017)
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. Additionally, 2 of the 84 Ryan Residency Training programs are available to family physicians.9 Advanced Practice Clinicians State licensing boards govern the scope of practice for APCs.
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. While abortion care is not specifically identified as a core competency for basic midwifery practice, CNMs have the essential skills to be trained to provide medication and aspiration abortions.
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Geographic Distribution There are marked geographic disparities in a woman's ability to access abortion services in the United States, mirroring the locations of fellowship and residency programs in family planning. Abortion providers tend to be concentrated in urban areas, and a paucity of abortion providers exists in the South and Midwest, creating geographic barriers for women seeking abortion services in these regions (Johns et al., 2017; Jones and Jerman, 2017a; Paul and Norton, 2016)
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From page 115... ...
. Women reported increased informational, cost, and logistical barriers to obtaining abortion services; increased cost and travel time; and a frustrated demand for medication abortion after the law took effect (Baum et al., 2016; Fuentes et al., 2016; Gerdts et al., 2016)
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. A 2012 survey of nonhospital abortion facilities estimated that at 10 weeks' gestation, the average charge for an aspiration abortion was $480 and for a medication abortion was $504 (Jerman and Jones, 2014)
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, APCs may provide medication abortions, and in 6 of those states plus DC, APCs are also permitted to perform aspiration abortions independently (Guttmacher Institute, 2017a; RHN, 2017)
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Both physicians (typically OB/GYNs and family medicine physicians, but other physicians can be trained) and APCs can provide medication 12Personal communication, O
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2017a. ACGME program requirements for graduate medical education in family medicine.
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obstetrics and gynecol ogy residency programs, 1998. Family Planning Perspectives 32(6)
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2007. Inte grating abortion training into family medicine residency programs.
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San Francisco, CA: UCSF Bixby Center for Global Reproductive Health. http://www.teachtraining.org/training-tools/early-abortion training-workbook (accessed October 20, 2017)
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Journal of the American Board of Family Medicine 26(6)
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2008. Required procedural training in family medicine residency: A consensus statement.
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2017. Family medicine residencies with abortion training.
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2017. The effects of abortion training on family medicine resi dents' clinical experience.
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2015. Women's satisfaction with abortion care in academic family medicine centers.
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