Challenges and Achievements of developing abortion care services in a rural setting in United Kingdom
ESC Congress Library. Ghosh M. May 10, 2018; 208092
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Dr. Madhusree Ghosh
Dr. Madhusree Ghosh
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Abstract
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Objectives:- The Hywel Dda University Health Board is responsible for providing care  to a population of 380k, who live in a rural area covering a quarter of the land mass of Wales. A review of the existing provision across three of the district general hospitals within the Health Board showed the care fell short of the standards set by the Royal College of Obstetrics and Gynaecology and Welsh Government recommendations on local delivery. The service was inequitable with over 300 women travelling to a neighbouring health board or to a charitable provider in England for care. The local service was of variable quality, it was not patient focussed and lacked leadership. Methods:- Following engagement with the gynaecology team and senior hospital management a lack of leadership was identified as a barrier to progress. The first step was appointment of a Lead Clinician for abortion care who was based within the Sexual Health Service. Failings were identified by clinical staff and stakeholders and the following developments have been made. 1) Self referral through a centralised appointment system implemented.  2) Increase in outpatient capacity. 3) An electronic patient recording system introduced. 4) Local Anaesthesia (LA) Manual Vacuum Aspiration (MVA) established, in addition to medical abortion. 5) STI screening, prophylaxis and appropriate management of positive results. 6) Pathways developed to offer all methods of contraception. 7) Patient satisfaction questionnaire introduced for feedback and service monitoring Results:- Improved access to the service has reduced waiting times. Increased choice of methods of termination after introduction of MVA under LA. Shared electronic patient record has allowed the sexual health team to treat women with positive STI results and provide partner notification. Improved contraceptive provision -Learning needs addressed by supporting clinical staff to complete the Faculty of Sexual and Reproductive Health ( FSRH)  diploma. Reduced harm from undiagnosed STI and potential complications from procedure by introducing universal STI screening and prophylaxis Conclusions:- Successful collaboration between Sexual Health, Gynaecology and stakeholders has resulted in a motivated team with a shared vision to improve the care of women seeking abortion. Future developments will aim to ensure the care provided meets national standards of care and in addition all women upto18 weeks gestation are treated locally. Developing a surgical abortion service, increasing access to MVA,  developing a very early medical abortion service, home termination and care within community based venues, are amongst the future plans. 
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