Ready for Self-Managed Medication Abortion? Practices, Confidence, Knowledge, and Attitudes of Emergency and Primary...

As more states restrict clinician-managed abortion, patients are increasingly using self-managed medication abortion (SMMA). Some patients may seek care after SMMA from emergency and primary care doctors. This study investigated the practices, confidence, knowledge, and attitudes related to post-SMMA care of emergency medicine (EM), family medicine (FM), and internal medicine (IM) physicians at an academic medical center and a Catholic non-profit health system in southeast Michigan.

We invited 505 EM, FM, and IM physicians to complete a confidential online survey. 167 participants (33%) completed the survey. We conducted descriptive analyses with chi-square analysis or Fisher's exact tests where appropriate.

Most participants had not knowingly cared for patients after SMMA but would if given the opportunity. Confidence with post-SMMA care differed significantly by specialty, with 80% of EM physicians, 63% of FM physicians, and 23% of IM physicians reporting confidence (p < 0.001). Overall knowledge of expected and unexpected symptoms after SMMA did not differ between specialties or locations; all specialties had notable knowledge gaps. Participants in the Catholic system were less likely to recognize the presentation after medication abortion as indistinguishable from spontaneous miscarriage (83% versus 96%, p < 0.05), and they were more likely to report feeling limited by their employer's policies (20% versus 4%, p = 0.001).

Most EM and primary care physicians are willing to provide post-SMMA care, but knowledge gaps exist. Physicians with religiously affiliated employers may face additional limitations. In the evolving landscape of abortion care, educational efforts should prepare physicians in all specialties to care for patients post-SMMA.