The Australian Contraceptive ChOice pRoject (ACCORd): Results of a cluster randomised controlled trial aimed at increasing Long Acting Reversible Contraceptive (LARC) uptake
Australasian Association of Academic Primary Care Conference (AAAPC) – winning presentation 2019 (selected by the AAAPC programme committee for presentation at SAPC ASM 2020)
LARCs reduce unintended pregnancy and abortion rates but Australian uptake is low. General practitioners (GPs) are ideally placed to promote LARCs.
The Australian Contraceptive ChOice pRoject (ACCORd), adapted from the US Contraceptive CHOICE study, evaluated whether a complex primary care intervention increased LARC uptake.
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.
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.
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.