GPs lacking information for abortion referral

Key guidelines fail to list public services that provide surgical and medical abortion services.

GPs don’t have access to adequate information when making decisions about abortion referrals, a report published today has found.

The study, led by Monash University’s GP department and published in the Australian Journal of Primary Health, found a key source of decision-making support lacked enough information about public healthcare services. The clinical advice given also varied between regions.

Researchers investigated the abortion content on HealthPathways, an online health information system used by GPs that outlines recommended management of common conditions and local referral options, usually to hospital services.

The review, conducted between January and June 2022, extracted abortion service referral data from the 17 of 34 HealthPathways portals that consented to be included. The portals covered all states and territories except Tasmania and South Australia.

“Nearly half (47%) [of the portals reviewed] had no public services listed for surgical abortion, while 35% had no public services for medical abortion,” the report said. “The majority – 64% for surgical abortion, 67% for medical abortion – emphasised that public services should be considered only as a last resort.

“The information varied between portals regarding gestation-specific options; the time-critical nature of referrals; and the importance of women’s own preferences when deciding between medical or surgical abortion.”

Since only about 10% of GPs in Australia are currently registered prescribers of medical abortion medications, a majority will refer a patient to seek abortion services outside of their primary care practice. GPs therefore need up-to-date and comprehensive information to support a patient’s decision-making, the report said.

In Australia, however, there is currently no transparent, coordinated referral system (comparable to that found in the UK) and no nationally reported data on the number and location of publicly-funded abortion services.

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HealthPathways is one of the few sources of information available. Each HealthPathway is linked to a PHN, and outlines a course of clinical assessment, management and referral to secondary or tertiary care based on local resources and services. But the portal has not previously been evaluated to understand abortion referral pathways and service availability.

“Many regions across Australia either do not have public abortion services or do not have information available to GPs about how to access these services,” the report said. “Limited public provision means that women will continue to experience barriers to abortion access.”

This problem is particularly acute in rural and remote areas of Australia, the researchers noted.

Without adequate information about how to access publicly-funded abortion services, GPs may not be able to provide the referral that would ensure the person seeking the service receives the best possible care.

“There is an urgent need for transparency around public abortion service availability, clear guidelines to support referral pathways, and commitment from state and federal governments to expand the availability of accessible, no-cost abortion in Australia,” the report said.

“Despite few remaining legal restrictions to abortion services in Australia and a universal public healthcare system, a truly equitable and accessible abortion service in Australia will require regional-level planning with commitment from state and federal governments towards their funding and implementation.”