Evaluation of the Miscarriage Care Initiative A Program to Integrate Comprehensive Early Pregnancy Loss Management in Primary Care Settings

摘要

BACKGROUND AND OBJECTIVES: Managing early pregnancy loss (EPL) withexpectant, medication, and manual vacuum aspiration (MVA) management inprimary care is safe, effective, and acceptable, yet, few family physicians provideall three care options. We implemented the Miscarriage Care Initiative (MCI)to help primary care organizations serving underserved communities and fam-ily medicine residencies integrate comprehensive EPL treatment options intopractice. This study evaluates the effect of the MCI on provision of EPL careand family physicians’ professional growth.METHODS: This mixed-methods, cross-sectional study included family physi-cian clinical champions from 13 sites who completed the MCI in 2013-2016.Participants were invited to complete surveys and phone interviews to assesstheir perceptions, experiences, and changes in clinical practice. We used de-scriptive statistics to summarize survey data; transcripts were coded and ex-amined through thematic analysis.RESULTS: All respondents completed surveys, and 11 (84.6%) completed in-terviews. After the MCI, nearly all sites (92.3%) offered expectant and medica-tion management options; eight (61.5%) provided MVA for EPL. All residenciesintegrated comprehensive EPL management into their didactic curricula. Com-mon challenges to integrating care included administrative resistance aroundEPL management similarities to abortion, and time to navigate logistics. TheMCI supported family physicians’ leadership development and may contributeto increased continuity of care.CONCLUSIONS: The MCI successfully expanded the availability of EPL man-agement options and residency training in primary care. Future research shouldexplore the program’s sustainability on EPL care provision and training, andstrategies to scale up such a model.