Patient experience with early pregnancy loss in the primary care setting: a qualitative study.

Abstract

Aim: This qualitative study describes patient perspectives on early pregnancy loss (EPL), the medical term for miscarriage, care in one federally qualified health centre (FQHC) that initiated provision of a mifepristone plus misoprostol regimen.

Background: EPL is a common pregnancy complication that can generally be treated by primary care providers (PCPs), yet many PCPs report barriers to providing the most effective medication regimen: mifepristone plus misoprostol. Limited data exist on patient experiences with EPL in the primary care setting.

Methods: Researchers conducted semi-structured interviews with a sample of patients who received EPL care from one Illinois FQHC between 2021 and 2022. Interview transcripts were coded and analysed to identify themes regarding how primary care can address patients' needs when experiencing pregnancy loss.

Results: Participants (n = 16) expressed satisfaction with EPL management at the FQHC, specifically that the option of medication management eased concerns about potential complications and provided clear expectations of the passage of the pregnancy. Medication management became a more accessible option for patients after the clinic began stocking mifepristone. Participant suggestions to improve EPL management in primary care included stronger and/or more timely analgesia, increased education, and mental health support. Participants identified barriers to EPL care including difficulty scheduling visits and perceived lack of urgency when triaged by clinic staff.

Conclusion: Patients report comfort with and interest in the option of medication management for EPL in the community-based primary care setting. Barriers in primary care clinic infrastructure and logistics must be considered and optimized to provide timely and safe EPL care.