Annals of Family Medicine: Two Papers Describe How Developing Systems and Enhancing Education for Mifepristone Use Can Lead to Greater Abortion Medication Access

ANN ARBOR, Mich., April 27, 2023 /PRNewswire/ -- With increased national focus on availability of mifepristone, one of two drugs used for medical abortion, two new papers in the Annals of Family Medicine explore clinical innovations used by family doctors to increase access to the drug in the primary care setting. 

Approved by the FDA in 2000, mifepristone is used, along with misoprostol, to end a pregnancy in the first 10 weeks of gestation and in miscarriage management. While misoprostol is readily available, mifepristone distribution has been restricted.

Despite its documented safety, mifepristone is regulated by the FDA's Risk Evaluation and Mitigation Strategy (REMS), which presents burdens for individual prescribers and limits its integration into primary care, where many patients seek help for unintended pregnancies.

One clinical innovation that could increase access to the drug in the family medicine context includes streamlining prescription ordering processes. Clinical researchers with the Department of Family Medicine and Community Health at the University of Minnesota Medical School, partnered with the university health system's compliance department to create standard processes for ordering and documenting mifepristone administration, which adhere to the REMS requirements.

They established a single prescriber account to represent all system prescribers who met REMS requirements, allowing for centralized ordering and distribution by the pharmacy purchasing team. This process mirrors other standard operating procedures used by the health system to purchase other medications.

Another intervention used in two Chicago-area federally qualified health centers, titled, "Excellence in Providing Access to New Directions in Mifepristone Use" (ExPAND Mifepristone), took a different approach to expanding access to the mifepristone. This learning collaborative, developed by researchers from the University of Chicago, Chicago-based medical centers, and Harvard Medical School, focused on enhancing educational and training support services for primary care providers to use the drug for miscarriage management and abortion provision.

Prior to program implementation, clinicians and staff had little knowledge of mifepristone. After implementation and program completion, both clinics stocked and provided mifepristone for early pregnancy loss. However, significant barriers remained for use of the drug as part of abortion care. Providers at both program sites noted that stringent financial procedures to separate federal funds from those that support abortion procedures proved a significant challenge.

Despite these obstacles, the researchers believe that the participating clinics' expanded ability to provide mifepristone for early pregnancy loss suggests that learning collaboratives could be an effective tool in improving access to comprehensive reproductive care.

Streamlining the Use of Mifepristone for Early Pregnancy Loss Across a Large Healthcare System Sets the Stage for Rapid Expansion of Medication Abortion Access in a Post-Roe Environment 

ExPAND Mifepristone: Medical Management of Miscarriage and Abortion in FQHCs 

SOURCE Annals of Family Medicine