title: Early pregnancy failure management among family physicians.
abstract: OBJECTIVE
  Family physicians, as primary care providers for reproductive-aged women, frequently initiate or refer patients for management of early pregnancy failure (EPF). Safe and effective options for EPF treatment include expectant management, medical management with misoprostol, and aspiration in the office or operating room. Current practice does not appear to reflect patient preferences or to utilize the most cost-effective treatments. We compared characteristics and practice patterns among family physicians who do and do not provide multiple options for EPF care.
  
  
  METHODS
  We performed a secondary analysis of a national survey of women's health providers to describe demographic and practice characteristics among family physicians who care for women with EPF. We used multivariate logistic regression to identify correlates of providing more than one option for EPF management.
  
  
  RESULTS
  The majority of family physicians provide only one option for EPF; expectant management was most frequently used among our survey respondents. Misoprostol and office-based aspiration were rarely used. Providing more than one option for EPF management was associated with more years in practice, smaller county population, larger proportions of Medicaid patients, intrauterine contraception provision, and prior training in office-based aspiration.
  
  
  CONCLUSIONS
  Family physicians are capable of providing a comprehensive range of options for EPF management in the outpatient setting but few providers currently do so. To create a more patient-centered and cost-effective model of care for EPF, additional resources should be directed at education, skills training, and system change initiatives to prepare family physicians to offer misoprostol and office-based aspiration to women with EPF.
authors: Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA 94110, USA. rwallace.research@gmail.com
authors: Robin
authors: R
authors: Wallace
authors: Christine
authors: C
authors: Dehlendorf
authors: Eric
authors: E
authors: Vittinghoff
authors: Katherine J
authors: KJ
authors: Gold
authors: Vanessa K
authors: VK
authors: Dalton
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000627:therapeutic use; D000022:Abortion, Spontaneous / Q000628:therapy*; D000328:Adult; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016595:Misoprostol / Q000627:therapeutic use; D057240:Patient Preference; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013396:Suction / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D057832:Watchful Waiting / Q000706:statistics & numerical data
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol