Implementation of No-Test Medication Abortions in Primary Care: A Roadmap from an Adolescent and Young Adult Medicine Clinic.

Study objective: Over two years post-Roe, 22 states have banned or significantly limited abortion access, exacerbating existing structural barriers to abortions for adolescents and young adults (AYA) including cost, transportation, parental notification requirements, and confidentiality concerns. We provide a roadmap and demonstrate the feasibility of implementing no-test medication abortions (MABs) to expand abortion access in an adolescent-focused pediatric primary care setting.

Methods: An interdisciplinary team in an AYA-focused primary care clinic developed and implemented a no-test MAB protocol. Iterative rounds of protocol development engaged stakeholders including hospital leadership, OBGYN consultants, nursing, and program directors for residency, fellowship, and nursing trainees. Frequent interdisciplinary debriefs identified facilitators, barriers, and solutions to optimize care.

Results: Over 6 months, we identified clinic champions, built relationships with key stakeholders, developed clinic protocols, and disseminated MAB clinical training. In our first 6 months of implementation, we provided 4 MABs. Facilitators identified by staff included provider expertise in AYA development and patient and parent preferences for MABs in their medical home. System-level barriers (e.g. timely scheduling challenges), staff factors (e.g. fear of complications), and patient factors (e.g. ambivalence about pregnancy) were identified. Solutions developed included establishing scheduling procedures, formalizing consultative pathways with gynecology, and integrating social work support.

Conclusion: It is feasible for adolescent primary care practices to provide no-test MABs. Through interdisciplinary planning and iterative design, barriers from the health system, clinic staff, and patient levels can be identified and addressed, expanding equitable access to safe, AYA-focused abortion care.