Mifepristone Implementation in Primary Care: Clinician and Staff Insights from a Pilot Learning Collaborative.

OBJECTIVES: The ExPAND Mifepristone learning collaborative (ExPAND) aims to support community-based primary care providers in overcoming logistical barriers to mifepristone provision. This qualitative study describes clinician and staff perspectives on the impact of ExPAND in two federally qualified health center networks (FQHCs).

STUDY DESIGN: Researchers interviewed a purposive sample of clinicians, staff members, and clinic leaders from two participating Illinois FQHCs using an interview guide grounded in the Consolidated Framework for Implementation Research. We analyzed interview transcripts in batches using grounded theory to identify themes regarding the reception of ExPAND, and barriers to and facilitators of program implementation.

RESULTS: Participants (n=13) expressed strong support for the provision of mifepristone for miscarriage management at their clinic sites. Generally, they personally supported mifepristone for both miscarriage management and abortion care. Many participants felt that ExPAND reflected their clinics' values as it strengthens the primary care relationship, focuses on patient-centered care, and addresses disparities in access. Some barriers to implementation include a fear that providing abortion care would jeopardize FQHC funding, as well as logistical hurdles due to the COVID-19 pandemic.

CONCLUSIONS: Participants felt that providing mifepristone in primary care settings was an important service for their patients and that ExPAND helped achieve that goal. The learning collaborative model can be used to support FQHCs incorporating miscarriage and abortion care. The findings of this study emphasize that in the future, clinics participating in ExPAND would benefit from education around how FQHCs can provide mifepristone for abortion care while complying with federal funding restrictions.

IMPLICATIONS STATEMENT: Learning collaboratives like ExPAND Mifepristone can help prepare primary care clinics to provide mifepristone. Clinicians and staff describe a clear benefit of mifepristone integration to their patient populations. Participants report mifepristone integration aligns with clinic values around patient-centered care and improved access to care.