Suchergebnisse

To develop a foundation for a national family planning research network, a core research team conducted several initiatives throughout the fall of 2011. Meetings with health system decision makers in public health and health services delivery from government, public and not-forprofit sectors across the nation were carried out to capture perceived gaps and opportunities as seen by knowledge users. As well, key informant interviews, and surveys among national organizations representing vulnerable populations and those representing health care professionals were conducted, and used to inform discussions at planning meetings with nationally representative health professionals and interdisciplinary academic researchers. Innovative models and important gaps emerging from each of these activities have been used to identify priorities for a programmatic community-based primary healthcare family planning research and researcher training agenda that could advance access to optimal contraception and abortion knowledge and services. The aim of this work is to improve the health of Canadian women and families by reducing unintended pregnancies and improving recognition of optimal pregnancy timing, so that women are able to achieve the healthiest pregnancies. Our goal is to undertake primary healthcare family planning research that will lead to improvements in equitable access to high quality family planning knowledge, services and methods, particularly among vulnerable women and families throughout Canada. Initiatives described here include: • National mixed methods surveys of stakeholders and primary healthcare clinicians • Expert Interviews with key stakeholders • A "Network Launch" consultation forum with Clinical Service providers • A planning meeting with key decision makers and interdisciplinary academic researchers to establish research program priorities This report will largely detail the latter of these activities, with findings from the former activities provided in the appendices. ; Medicine, Faculty of ; Non UBC ; Family Practice, Department of ; Unreviewed ; Faculty ; Other

BackgroundThe shifting landscape of abortion care from a hospital-only to a distributed service including primary care has implications for how to identify abortion cohorts for research and surveillance. The objectives of this study were to 1) create an improved approach to define abortion cohorts using linked administrative data sets and 2) evaluate the performance of this approach for abortion surveillance compared with standard approaches.
MethodsWe applied four principles to identify induced abortion cohorts when some services are delivered beyond hospital settings; 1) exclude early pregnancy losses and postpartum procedures; 2) use multiple data sources; 3) define episodes of care; 4) apply a hierarchical algorithm to determine abortion date to a population-based cohort of all abortion events in Ontario (Canada) from January 1, 2018-March 15, 2020. We calculated risk differences (RD, with 95% confidence intervals) comparing the proportion of medication vs. surgical, first vs. second trimester, and complication incidence applying these principles vs. standard approaches.
ResultsHospital-only data (versus multiple data sources) underestimated the frequency of medication abortion (16.1% vs. 31.4%; RD -15.3% [-14.3, -16.3]) and first-trimester abortion (82.1% vs. 94.5%; RD -12.8 [-11.4, 13.4]) and overestimated incidence of abortion complication (2.9% vs. 0.69%; RD 2.2% [1.8, 2.7]). An unlinked (versus linked) approach underestimated the frequency of abortion complications (0.19% vs 0.69%, -RD 0.50% [-0.44 - -0.56]). Including (versus excluding) abortions following early pregnancy loss or delivery events increased the estimated incidence of abortion complications (1.29% vs. 0.69%, RD 0.60% [0.51-0.69].
ConclusionNew methods are required to accurately identify abortion cohorts for surveillance or research. When legal or regulatory approaches to medication abortion evolve to enable abortion in primary care or office-based settings, hospital-based surveillance systems will become incomplete and biased; to continue valid and complete abortion surveillance, methods must be adjusted to ensure complete capture of procedures across all settings.

This publication was prepared as part of the NQF-in Project Developing Organisational and Financial Models for Including Non-Formal Sector Qualifications in National Qualifications Frameworks financed by the European Union within the framework of the Erasmus+ Programme. It consists of two volumes: Volume I – Country Reports, Volume II – Annexes to the Country Reports, both published in electronic format. ; The aim of the NQF-in Project is to provide evidence-based support to national governments, EU agencies and key stakeholders in developing policies for including qualifications in national qualifications frameworks, with a particular focus on qualifications awarded outside the formal education system (non-formal sector qualifications). This aim is achieved by conducting two sets of activities in the project: (1) providing systematised knowledge about the organisational and financial solutions applied in seven EU countries for including non-formal sector qualifications in their NQF-based systems, and (2) developing organisational and financial models for the inclusion of non-formal sector qualifications in NQF-based systems. ; European Union. Erasmus+ Programme