The Australian Contraceptive ChOice pRoject (ACCORd): Results of a cluster randomised controlled trial aimed at increasing Long Acting Reversible Contraceptive (LARC) uptake

Conference: 
SAPC ASM 2020 - cancelled due to pandemic
Talk Code: 
A.0a
Presenter: 
Professor Danielle Mazza
Co-authors: 
Professor Danielle Mazza (1). Dr Cathy Watson (1), Professor Kirsten Black (2). Professor Jayne Lucke (3). Professor Angela Taft (4), Dr Kevin McGeechan (5), Professor Marion Haas (6), Dr Kathleen McNamee (7), Professor Jeffrey Peipert (8)
Author institutions: 
1) Department of General Practice Monash University 2) Obstetrics, Gynaecology and Neonatology, University of Sydney 3) Australian Research Centre for Sex, Health and Society (ARCSHS). La Trobe University 4) Judith Lumley Centre, La Trobe University 5) School of Public Health, University of Sydney 6) Centre for Health Economics Research and Evaluation, University of Technology Sydney 7) Family Planning Victoria 8) Obstetrics and Gynecology, Indiana University School of Medicine

Australasian Association of Academic Primary Care Conference (AAAPC) – winning presentation 2019 (selected by the AAAPC programme committee for presentation at SAPC ASM 2020)

Context

LARCs reduce unintended pregnancy and abortion rates but Australian uptake is low. General practitioners (GPs) are ideally placed to promote LARCs. 

Objective

The Australian Contraceptive ChOice pRoject (ACCORd), adapted from the US Contraceptive CHOICE study, evaluated whether a complex primary care intervention increased LARC uptake.

Study Design

Cluster randomised controlled trial in general practices in Melbourne, Australia. Intervention GPs received training to deliver structured contraceptive counselling with contraceptive effectiveness emphasis and access to rapid referral to LARC insertion clinics. Control GPs had access to neither. Primary outcome: number of LARCs inserted. Data collected from women at baseline (telephone interview), six months (online survey) and from GPs and gynaecologists during contraceptive consultation and at time of contraception uptake.

Participants

GPs: worked 3+ sessions weekly, computerised practice and supportive reception staff. Women: attended GP, English speaking, sexually active, not pregnant, not planning pregnancy in following year, 16–45 years, interested in contraceptive counselling.

Findings

Twenty-five intervention GPs and 32 control GPs recruited 307 and 433 women (N=740). Referral for LARC insertion within 4 weeks of initial consultation - Intervention: 37%; Control: 18% (RR 1.98, 95% CI 1.39-2.8; p<0.001). LARC inserted by 4 weeks - Intervention: 19%; Control: 12% (RR 2.03, CI 1.06-3.89; p=0.033). Using LARC at 6 months - Intervention: 45%; Control: 29% (RR1.66, 95%CI 1.28-2.16; p<0.001). No difference in age nor parity with LARC uptake across groups.

Implications for practice

ACCORd intervention resulted in significantly more LARC uptake at 4 weeks and 6 months and has potential to reduce unintended pregnancies.