197712 Outpatient surgical miscarriage management: Attitudes and perceived barriers among family medicine providers

Monday, November 9, 2009: 2:50 PM

Blair Grant Darney, MPH , Department of Health Services, University of Washington, Seattle, WA
Jeana Kimball, ND, MPH , Department of OB/Gyn, University of Washington, Seattle, WA
Deborah VanDerhei, BSW , Department of Family Medicine, University of Washington, Seattle, WA
Nancy Stevens, MD, MPH , Department of Family Medicine, University of Washington, Seattle, WA
Sarah Prager, MD, MAS , Department of OB/Gyn, University of Washington, Seattle, WA
Background. Outpatient surgical miscarriage management (OSMM) is safe and may improve patient satisfaction and decrease costs compared to operating room management. Training family medicine (FM) physicians and staff in OSMM could increase access to evidence-based women's health care. This study aimed to characterize attitudes and perceived barriers to OSMM in FM practice settings.

Method. We administered a survey to elicit attitudes and perceived barriers (33 likert scaled items) to OSMM to faculty, residents, and clinical and administrative support staff at five diverse FM residency sites in Washington State. We used multivariate linear regression models to assess the association of attitudes about OSMM as appropriate care and perceived barriers to implementing OSMM across roles (faculty, resident, staff), controlling for sex, age, and residency site.

Results. 105 residents, 49 faculty, and 81 staff completed the survey (76% response rate). While attitudes towards OSMM were positive on average (mean 50.6 out of 70; range 18-66), mean perceived barriers to implementation of OSMM were often “neutral,” but exhibited much variation (mean 58.9 out of 95; range 19-95). Compared to faculty, residents (p = 0.05) and staff (p < 0.001) had significantly lower attitude scores, but similar barrier scores.

Conclusion. There may be differences in attitudes towards OSMM depending on role; FM faculty reported more positive views of OSMM than residents, and all physicians were more positive than support staff. Perceived barriers, such as lack of training and historical practice patterns, exist. Interventions to integrate OSMM into FM settings should address attitudes and perceived barriers and include support staff.

Learning Objectives:
1. Explain why outpatient surgical miscarriage management can be appropriate in family medicine settings 2. Describe the relationship of attitudes and perceived barriers to clinic role 3. Discuss the potential role of attitudes and perceived barriers to integrating outpatient surgical miscarriage management into family medicine settings.

Keywords: Women's Quality Care, Evidence Based Practice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I lead the analysis of the survey results we are presenting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.