Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice

Mazza, Danielle; Shankar, Mridula; Botfield, Jessica R.; Moulton, Jessica E; Chakraborty, Samantha; Black, Kirsten; Tomnay, Jane; Bateson, Deborah; Church, Jody; Laba, Tracey‐Lea; Kasza, Jessica; Norman, Wendy V.

doi:10.1136/bmjopen-2022-065137

Cited by 4 publications

(1 citation statement)

References 56 publications

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“…45 While nurse-led models of care are well established to support chronic disease management in Australian primary care, [46][47][48] their place in LARC and EMA services is still evolving. 17 Recent Australian regulatory changes now permit expanded prescribing of EMA by nurse practitioners and endorsed midwives in line with state-based legislation. 49 The practical and professional needs of nurses and nurse practitioners around LARC and EMA provision are likely to change as their role in direct service provision emerges in line with these regulatory developments.…”

Section: Discussionmentioning

confidence: 99%

What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice

Srinivasan,

James,

Kwek

et al. 2024

BMJ Sex Reprod Health

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BackgroundUptake of long-acting reversible contraception (LARC) is lower in Australia compared with other high-income countries, and access to early medical abortion (EMA) is variable with only 11% of general practitioners (GPs) providing EMA. The AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) Network is a virtual community of practice established to support GPs, nurses and pharmacists to provide LARC and EMA in primary care. Evaluating participant engagement with AusCAPPS presents an opportunity to understand clinician needs in relation to LARC and EMA care.MethodsData were collected from July 2021 until July 2023. Numbers of online resource views on AusCAPPS were analysed descriptively and text from participant posts underwent qualitative content analysis.ResultsIn mid-2023 AusCAPPS had 1911 members: 1133 (59%) GPs, 439 (23%) pharmacists and 272 (14%) nurses. Concise point-of-care documents were the most frequently viewed resource type. Of the 655 posts, most were created by GPs (532, 81.2%), followed by nurses (88, 13.4%) then pharmacists (16, 2.4%). GPs most commonly posted about clinical issues (263, 49% of GP posts). Nurses posted most frequently about service implementation (24, 27% of nurse posts). Pharmacists posted most about health system and regulatory issues (7, 44% of pharmacist posts).ConclusionsGPs, nurses and pharmacists each have professional needs for peer support and resources to initiate or continue LARC and EMA care, with GPs in particular seeking further clinical education and upskilling. Development of resources, training and implementation support may improve LARC and EMA provision in Australian primary care.

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Section: Discussionmentioning

confidence: 99%

What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice

Srinivasan,

James,

Kwek

et al. 2024

BMJ Sex Reprod Health

Self Cite

View full text Add to dashboard Cite

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A nurse‐led model of care to improve access to contraception and abortion in rural general practice: Co‐design with consumers and providers

Moulton,

Arefadib,

Botfield

et al. 2024

Journal of Advanced Nursing

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AimTo describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice.DesignCo‐design methodology informed by the Experience‐Based Co‐Design Framework.MethodsConsumers, nurses, physicians and key women's health stakeholders participated in a co‐design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six‐step process for thematic analysis.ResultsFifty‐two participants took part in the co‐design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient‐approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.ConclusionOur approach to experience‐based co‐design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse‐led model of care.Implications for the Profession and/or Patient CareThe co‐designed nurse‐led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.ImpactNurse‐led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse‐led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.Reporting MethodReported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.Patient or Public ContributionTwo consumer representatives contributed to the development of the co‐design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

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Changes in the numbers of hospital‐based abortions and outpatient early medical abortions in Victoria, 2012–22: a retrospective cohort study

Marzan,

Johnson,

Moore

et al. 2024

Medical Journal of Australia

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ObjectivesTo assess changes in the monthly numbers of hospital‐based abortions and outpatient early medical abortions in Victoria during January 2012 – March 2022, with a particular interest in the impact of the coronavirus disease 2019 (COVID‐19) pandemic.Study designPopulation‐based retrospective cohort study; time series analysis of Victorian Admitted Episodes Dataset (VAED) and Pharmaceutical Benefits Scheme (PBS) data.Setting, participantsAll admitted care episodes in Victoria during 1 January 2012 – 31 March 2022 with medical abortion as the principal diagnosis; all PBS claims for mifepristone–misoprostol (MS‐2 Step) during 1 January 2015 (date of listing) – 31 March 2022.Main outcome measuresChanges in monthly numbers (with 95% confidence intervals [CIs]) of admissions for hospital‐based and outpatient early medical abortions during the pre‐pandemic period (January 2012 – March 2020), the first full month of the COVID‐19 pandemic (April 2020), and the pandemic period (May 2020 – March 2022).ResultsThe monthly number of hospital‐based abortions declined in Victoria during the pre‐pandemic period (slope, –2.92 [95% CI, –3.45 to –2.38] per month); the rate of decline was greater during the pandemic period (slope, –5.74 [95% CI, –10.5 to –0.96] per month). The monthly number of outpatient early medical abortions increased during the pre‐pandemic period (slope, 5.94 [95% CI, 5.34–6.34] per month); it declined during the first month of the pandemic (slope, –26.4 [95% CI, –70.1 to –17.3] per month), but did not significantly change thereafter. The total monthly number of abortions during the pandemic period did not deviate markedly from the pre‐pandemic median value. The pre‐pandemic declines in monthly numbers of abortions in major city hospitals, in private hospitals, or at earlier than 14 weeks’ gestation intensified during the pandemic period. During January 2015 – March 2020, 14 634 of 103 496 abortions were outpatient medical abortions (14%); during the pandemic period, 11 154 of 33 056 abortions were outpatient medical abortions (33%).ConclusionsThe use of outpatient early medical abortion has steadily increased in Victoria since the PBS listing of mifepristone–misoprostol, which helped ensure access to abortion during the COVID‐19 pandemic. Outpatient medical abortions may eventually outnumber surgical early abortions in Victoria, but they are not always appropriate: hospitals will continue to be essential for comprehensive abortion care.

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Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice

Cited by 4 publications

References 56 publications

What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice

What do Australian primary care clinicians need to provide long-acting reversible contraception and early medical abortion? A content analysis of a virtual community of practice

A nurse‐led model of care to improve access to contraception and abortion in rural general practice: Co‐design with consumers and providers

Changes in the numbers of hospital‐based abortions and outpatient early medical abortions in Victoria, 2012–22: a retrospective cohort study

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