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ForwardPerformance Improvement: Supporting Access to Abortion through Primary Care
Have you been wondering if there is a better way to incorporate pregnancy options counseling and abortion education, abortion referrals or medication abortion into your primary care practice? Many family docs are worried that they don’t have the expertise to provide abortion care, but that isn’t the case! In fact, family docs provide much more complex services every day in their practices.
This performance improvement module was developed by a team of family medicine faculty with advanced expertise in providing abortion care to help you overcome common institutional and systems-level barriers to delivering same-day services to patients with a positive pregnancy test who are considering an abortion.
Despite the evidence that both patients and physicians support the inclusion of reproductive health services in primary care, family physicians continue to encounter systems-level barriers to integrate abortion services, including restrictive institutional policies and administrative resistance. In order to overcome these barriers, physicians must acquire new knowledge and skills to navigate the state, federal, institutional, and logistic challenges that arise when integrating abortion into primary care.
In this performance improvement (PI) project, participants will measure same-day initiation of abortion-related services (defined as options counseling and abortion education, abortion referrals or medication abortion care) at baseline and again after implementing at least one Plan Do Study Act (PDSA) cycle, and then reflect on resulting practice improvement.
Same-day initiation of abortion-related services is measured by calculating one of the following metrics:
- % of pregnant patients who request options counseling and education on abortion for whom abortion education is delivered on the same day as patient request
- % of pregnant patients who request an abortion referral for whom a referral is placed on same day as patient request
- % of pregnant patients who request a medication abortion for whom a medication abortion is scheduled or provided on same day as patient request
The intention of these metrics is to acknowledge that, while care for a patient seeking an abortion may be ongoing and require follow-up, the primary care provider should be prepared to begin that process on the day the patient expresses the need for such care in order to improve patient access.
Learning Objective
This PI project is designed to support access to abortion through same-day initiation of options counseling and abortion education, abortion referrals or medication abortion care in primary care settings.
Target Audience
This activity is designed for family medicine physicians, residents and other members of the primary care team working in a variety of settings.
Participation and Credit
Learners must complete the project by March 3, 2027 to receive credit for this performance improvement activity. Requirements are to:
- read the course information thoroughly, including target audience, learning objectives, and author disclosures
- study the educational content online
- submit baseline data
- complete the PDSA project
- submit data and attestation
- complete the activity evaluation
Your certificate will be available to you as a downloadable link. You may print the certificate, but you cannot alter it. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
Participating with a Practice Team/Partnering with Another Clinic
Multiple learners may participate from the same practice, analyzing a single set of data, or providers in small clinics can choose to join together with another practice to complete this module. Each learner must be enrolled in the PI project separately and complete each step of the project in this portal, although the data collection and PDSA steps may be performed collectively by the team/partners.
Unlabeled Use Disclosure
This activity will not include discussions of products or devices that are not currently approved for use by the Food and Drug Administration (FDA), and the curriculum clearly indicates this fact.
Support
This activity is sponsored by the California Academy of Family Physicians Foundation, supported by Essential Access Health and the California Department of Public Health.
Fee
There is no charge for this activity.
Cultural/Linguistic Competency
CAFP policy and California state law requires that each learning activity have elements of cultural and linguistic proficiency included in the content. The definition of cultural and linguistic competency is the ability and readiness of health care providers and health organizations to humbly and respectfully demonstrate, effectively communicate, and tailor delivery of care to patients with diverse values, beliefs, identities, and behaviors, in order to meet patients’ social, cultural, and linguistic needs as it relates to patient health. This activity meets these requirements.
Implicit Bias
CAFP policy and California state law requires that all CME activities comprising a patient care element include either (1) examples of how implicit bias affects perceptions and treatment decisions of physicians and surgeons, leading to disparities in health outcomes and/or (2) strategies to address how unintended biases in decision-making may contribute to health care disparities by shaping behavior and producing differences in medical treatment along lines of race, ethnicity, gender identity, sexual orientation, age, socioeconomic status, or other characteristics. This activity meets these requirements.
Privacy Policy
The California Academy of Family Physicians (CAFP) is committed to protecting the privacy of its members and customers. CAFP maintains safeguards to store and secure information it has about members and customers. The safeguards may be physical, electronic or procedural. For more information, see our website or contact [email protected].
Questions
For questions regarding the content of this activity or for technical assistance, contact [email protected].
The CAFP has made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education program. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the learner is advised to check the manufacturer's package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
Approval of credit for this continuing education program does not imply endorsement by CAFP of any product or manufacturer identified.
Any medications or treatment methods suggested in this CME activity should not be used by the practitioner without evaluation of their patient's condition(s) and possible contraindication(s) or danger(s) of use of any specific medication.
Copyright:
© 2025 California Academy of Family Physicians. No part of this activity may be used or reproduced in any manner whatsoever without written permission except in the case of brief quotations embedded in articles or reviews.
Sheila Attaie, DO
Dr. Sheila Attaie (she/her) is an Iranian-American family physician from the Sacramento area. She is an assistant clinical professor in the Department of Family and Community Medicine at University of California, Davis. She is also a contract provider with Lilith Clinic and Planned Parenthood Great Plains, as well as a volunteer for the M+A hotline. Her interests in medicine include abortion liberation, refugee and immigrant health, and mental health. Outside of medicine, she fills her cup with hiking, snowboarding, dancing, DJing, and international travel!
Disclosure: Dr. Attaie has no relevant financial relationships with ineligible companies to disclose.
Shannon Connolly, MD, FAAFP
Dr Connolly completed medical school at the University of Southern California and residency in family medicine at UCLA. She is currently the Associate Medical Director at Planned Parenthood of Orange and San Bernardino Counties, where she oversees primary care and behavioral health care. She has served as president of the California Academy of Family Physicians and is currently Chair of the Committee on Justice through Equity, Diversity, and Inclusion for the CAFP. Additionally, she sits on the Commission for Diversity, Equity, and Inclusion in Family Medicine for the American Academy of Family Physicians. Her clinical interests include abortion and family planning, gender affirming care, and health equity.
Disclosure: Dr. Connolly has no relevant financial relationship(s) with ineligible companies to disclose.
C. Peony Khoo, MD, FAAFP
Dr. Khoo (she/her) is a family physician in downtown Los Angeles. She serves as the Associate Program Director at the California Hospital Medical Center Family Medicine Residency Program where she provides full-spectrum family medicine care, including surgical obstetrics. She is also a Supervising Physician at Planned Parenthood Pasadena and San Gabriel Valley. She serves in leadership positions in family medicine in local, state, and national committees. Her clinical interests include reproductive health, obstetrics, addiction medicine, and lactation/breastfeeding medicine.
Disclosure: Dr. Khoo has no relevant financial relationships with ineligible companies to disclose.
Amy Tressan, MD
Dr. Tressan (she/her) completed medical school at Thomas Jefferson Medical College in Philadelphia and residency in family medicine at UCLA. She then completed her medical training with a family planning fellowship with the Reproductive Health Access Project in Boston. She is currently the Clinical Manager of Surgical and Specialty Services at Planned Parenthood of Orange and San Bernardino Counties, where she practices comprehensive primary care. Her areas of clinical interest include diversity and equity within healthcare delivery, trauma informed care, abortion access, and gender affirming care. Outside of work, Dr. Tressan is involved in several professional organizations which focus on advocacy for access to family planning services.
Disclosure: Dr. Tressan has no relevant financial relationships with ineligible companies to disclose.
Aisha Wagner, DO
Dr. Wagner completed medical school at the Keck School of Medicine and residency at University of California, San Francisco. She then went on to do a fellowship in Reproductive Health and Advocacy in New York through the Reproductive Health Access Project, as well as a fellowship with Physicians for Reproductive Health. Dr. Wagner currently works providing primary care at an FQHC, as a contract provider for Planned Parenthood Los Angeles, fellowship director for TEACH (Training in Early Abortion for Comprehensive Healthcare), and recently as the co-Chief Medical Officer for Choix Health, a telehealth platform offering MAB.
She has created and collaborated on reproductive health, reproductive rights, and reproductive justice advocacy projects, taught women’s health procedures (including abortion) to medical students, residents, nurse practitioners, and other medical professionals. She has also spoken as an expert on contraception and abortion care with media, state representatives, on panels, and as an invited Grand Rounds speaker. In her free time (which is very limited these days) she enjoys buying ridiculous numbers of plants.
Disclosure: Dr. Wagner has no relevant financial relationships with ineligible companies to disclose.
Conflict of Interest Statements
The Committee on Continuing Professional Development and CME will be responsible for mitigating any relevant financial relationships disclosed by an individual who may have influence on content, who have served as faculty, or who may produce CME/CPD content for the CAFP. Mitigation may include learner notification, peer review of content before presentation, requirement of EB-CME, changing topics, or even dismissing a potential faculty member.
It is the policy of the CAFP to ensure independence, balance, objectivity, scientific rigor, and integrity in all continuing education activities. All individuals with potential to influence the content of this program have submitted Disclosure of Interest declarations that have been reviewed according to policy. Learner notification of declarations is below. All individuals with relevant financial relationships with ineligible companies have been contacted by CAFP staff or CCPD members, and issues of conflict have been discussed and mitigated.
CME Planners
The following planners have no financial relationships with ineligible companies to disclose: Laurie Isenberg, MA, MILS, CHCP, and Brittany Perrotte, MPH.
This activity has been approved by the American Board of Family Medicine (ABFM) for Family Medicine Certification credit. Term of approval is for 04/01/2025 to 03/31/2027.
The AAFP has reviewed Performance Improvement: Supporting Access to Abortion through Primary Care and deemed it acceptable for up to 20.00 Performance Improvement AAFP Prescribed credit(s). Term of Approval is from 03/03/2025 to 03/2/2027. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The California Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The California Academy of Family Physicians designates this educational activity for a maximum of 20 AMA PRA Category 1 Credit(s). TM
Available Credit
- 20.00 AAFP Prescribed
- 20.00 AMA PRA Category 1 Credit™