JMIR Publications

ABSTRACT

Background:

Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced into Canada in 2017 for medical abortion. We created a VCoP to support implementation of this medical abortion practice across Canada.

Objective:

To describe the development and utilization of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l’avortement (CAPS-CPCA) VCoP and explore physicians’ experience with CAPS-CPCA and their views on its value in supporting implementation.

Methods:

This was a mixed methods intrinsic case study of Canadian clinicians’ utilization and perceptions of the CAPS-CPCA VCoP during the first two years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP, and those who were interested to provide the novel practice but did not join the VCoP. We designed the VCoP features to address known barriers to implementation of medical abortion in primary care. Our secure on-line platform allowed asynchronous access to information, practice resources, clinical support, discussion forums and email notices. We collected data from the platform, surveys of physician members, and interviews with member and non-member physicians. We analyzed descriptive statistics for website metrics, physician characteristics and practices, and their use of the VCoP. We used qualitative methods to explore their experiences and perceptions of the VCoP.

Results:

From January 1, 2017 to June 30, 2019, 430 physicians representing all provinces and territories in Canada joined the VCoP. Of the 222 who completed a baseline survey, 70.3% were family physicians, 80.2% were female and 35% had no prior abortion experience. Twelve months after baseline, 77.9% of those surveyed had provided mifepristone abortion and one-third said the website was helpful or very helpful. Logging into the site was burdensome for some, but members valued downloadable resources (eg. patient information, consent forms, clinical checklists), and found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but members felt this feature was important for isolated or rural providers. Information collected through member polls about regulatory barriers to implementation was used in the project’s knowledge translation activities with policymakers to mitigate those barriers.

Conclusions:

A VCoP developed to address known and discovered barriers to uptake of a novel medical abortion method was successful in engaging and supporting physicians from across Canada to implement this practice, including many with no prior abortion experience.