Willing and able? Provision of medication for abortion by future internists.
BACKGROUND
The development of medications such as mifepristone (RU486) has created the opportunity to introduce medication abortion as a component of office practice.


METHODS
Two hundred twelve residents training in internal medicine, family practice, and gynecology at 11 residency programs completed anonymous surveys assessing willingness to provide medication for abortion and perceived barriers to future provision of mifepristone.


RESULTS
Residents training in internal medicine knew less about mifepristone and preabortion screening than other primary care trainees. Forty-two percent of internists, 84% of family practitioners, and 83% of gynecologists were willing to prescribe mifepristone (p < .001). Many internists were concerned about lacking adequate "backup" access to vacuum aspiration services (84% of internists, 74% of family practitioners, 35% of gynecologists; p < .001). In multivariable analysis, the training-related factors most predictive of whether an internist was willing to provide medication for abortion were feeling that mifepristone is very safe, abortion services are needed by the patients served, knowing to check an ultrasound before inducing abortion, and having no concern of how to manage bleeding or of lacking adequate backup should vacuum aspiration be needed.


CONCLUSIONS
Many (42%) future internists are willing to provide mifepristone, but most lack adequate knowledge of mifepristone and preabortion screening. As access to abortion services is limited in many U.S. counties, internists who are willing to provide mifepristone should be offered the necessary training to do so safely.
Schwarz
Eleanor Bimla
EB
Department of Medicine, General Internal Medicine Section (111a1), University of California-San Francisco, VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA. Schwarz@medicine.ucsf.edu
Luetkemeyer
Anne
A
Foster
Diana Greene
DG
Weitz
Tracy A
TA
Lindes
Deborah
D
Stewart
Felicia H
FH
D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000592:standards; D001291:Attitude of Health Personnel; D002140:California; D002983:Clinical Competence / Q000592:standards; D003283:Contraceptives, Postcoital, Synthetic / Q000008:administration & dosage*; D005194:Family Practice / Q000592:standards; D006801:Humans; D007388:Internal Medicine / Q000592:standards; D007396:Internship and Residency / Q000592:standards*; D008600:Menstruation-Inducing Agents / Q000008:administration & dosage; D015735:Mifepristone / Q000008:administration & dosage*; D015999:Multivariate Analysis; D011795:Surveys and Questionnaires
D000021:Abortifacient Agents, Steroidal; D003283:Contraceptives, Postcoital, Synthetic; D008600:Menstruation-Inducing Agents; D015735:Mifepristone