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ImportanceBefore 2021, the US Food and Drug Administration required mifepristone to be dispensed in person, limiting access to medication abortion.ObjectiveTo estimate the effectiveness, acceptability, and feasibility of dispensing mifepristone for medication abortion using a mail-order pharmacy.Design, setting, and participantsThis prospective cohort study was conducted from January 2020 to May 2022 and included 11 clinics in 7 states (5 abortion clinics and 6 primary care sites, 4 of which were new to abortion provision). Eligible participants were seeking medication abortion at 63 or fewer days' gestation, spoke English or Spanish, were age 15 years or older, and were willing to take misoprostol buccally. After assessing eligibility for medication abortion through an in-person screening, mifepristone and misoprostol were prescribed using a mail-order pharmacy. Patients had standard follow-up care with the clinic. Clinical information was collected from medical records. Consenting participants completed online surveys about their experiences 3 and 14 days after enrolling. A total of 540 participants were enrolled; 10 withdrew or did not take medication. Data were analyzed from August 2022 to December 2023.InterventionMifepristone, 200 mg, and misoprostol, 800 µg, prescribed to a mail-order pharmacy and mailed to participants instead of dispensed in person.Main outcomes and measuresProportion of patients with a complete abortion with medications only, reporting satisfaction with the medication abortion, and reporting timely delivery of medications.ResultsClinical outcome information was obtained and analyzed for 510 abortions (96.2%) among 506 participants (median [IQR] age, 27 [23-31] years; 506 [100%] female; 194 [38.3%] Black, 88 [17.4%] Hispanic, 141 [27.9%] White, and 45 [8.9%] multiracial/other individuals). Of these, 436 participants (85.5%; 95% CI, 82.2%-88.4%) received medications within 3 days. Complete abortion occurred after medication use in 499 cases (97.8%; 95% CI, 96.2%-98.9%). There were 24 adverse events (4.7%) for which care was sought for medication abortion symptoms; 3 patients (0.6%; 95% CI, 0.1%-1.7%) experienced serious adverse events requiring hospitalization (1 with blood transfusion); however, no adverse events were associated with mail-order dispensing. Of 477 participants, 431 (90.4%; 95% CI, 87.3%-92.9%) indicated that they would use mail-order dispensing again for abortion care, and 435 participants (91.2%; 95% CI, 88.3%-93.6%) reported satisfaction with the medication abortion. Findings were similar to those of other published studies of medication abortion with in-person dispensing.Conclusions and relevanceThe findings of this cohort study indicate that mail-order pharmacy dispensing of mifepristone for medication abortion was effective, acceptable to patients, and feasible, with a low prevalence of serious adverse events. This care model should be expanded to improve access to medication abortion services.

The nursing shortage continues to grow, leaving healthcare systems and patients in a precarious situation. A major reason for the shortage is the lack of nursing faculty to educate future nurses, which has hindered nursing programs nationwide from accepting students interested in a nursing career. This qualitative study explored the existing academic nurse educator shortage and sought solutions that an important stakeholder group, the public and business sector/business owners, might implement to mitigate the dual shortage of professional nurses and academic nurse educators. Using a modified Nominal Group Technique (NGT) design, the research team identified five major stakeholder groups which could benefit from addressing the academic nurse educator shortage. Team subgroups reviewed relevant literature and crafted recommendations to address the academic nurse educator shortage. This article discusses findings from one of these major stakeholders: the public and business/business owner sectors. Forty-five academic nurse educators were recruited from volunteers engaged in a national nursing education online forum and 25 participants completed the study. Five themes emerged: encourage lobbying efforts with legislators; engage the media in exposing the relationship of the academic nurse educator shortage and the nursing shortage; incentivize higher education opportunities for nurses to become academic nurse educators; elevate the life experience of patients; and stakeholder collaboration. A continued partnership between the public/business sectors/business owners and leaders within the profession of nursing must exist to enhance the academic nurse educator role. Only with this partnership can those within the profession of nursing continue to serve the public sustainably for years to come. [ABSTRACT FROM AUTHOR]