The ORIENT trial: protocol for evaluating the effect of a nurse-led model on contraception and medical abortion access in Australian rural & regional general practice

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

3E.3

Presenter:

Danielle Mazza

Twitter:

@Danielle_Mazza

Co-authors:

Danielle Mazza, Asvini K. Subasinghe, Mridula Shankar, Jessica R. Botfield, Samantha Chakraborty, Jessica E. Moulton, Kellie Hamill, Kirsten Black, Jane Tomnay, Deborah Bateson, Kevin McGeechan, Tracey Laba, Wendy V. Norman

Author institutions:

Monash University, Family Planning NSW, The University of Sydney, University of Technology Sydney, University of British Columbia, London School of Hygiene and Tropical Medicine

Problem

Women in rural and regional Australia often experience difficulties accessing long-acting reversible contraception (LARC) and medical abortion. Collaborative nurse-led models have been successfully applied in community health and family planning settings, but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial is to assess the effectiveness of a nurse-led model of care, involving task-sharing between general practitioners (GPs) and practice nurses, at increasing uptake of LARC and improving access to medical abortion in rural and regional areas.

Approach

ORIENT is a stepped-wedge pragmatic cluster randomised controlled trial. We will recruit and enrol 32 general practices (clusters) that are in rural or regional Australia, and have at least two general practitioners, one practice nurse and one practice manager per cluster. The nurse-led model of care (the intervention) will be co-designed with healthcare providers, consumers, researchers, and women’s health advocates. Clusters will be randomised to implement the model in a sequential manner, with the comparator being usual care. Clusters will receive implementation support to apply the nurse-led model through the following activities: (a) online clinical upskilling on LARC and medical abortion, (b) educational outreach with clinical opinion leaders to discuss practical strategies for customised implementation of the model in participating practices, and (c) engagement in an online professional community of practice for access to clinical expertise, resources and peer-support to deliver contraception and medical abortion services. Recruitment of practices into the trial will begin in March 2022.

Findings

The primary outcome that will be assessed is the change in the rate of LARC prescribing comparing control and intervention phases. Secondary outcomes will include the change in the rate of prescribing of the medical abortion combination regimen medication mifepristone and misoprostol and provision of related telehealth services. A within-trial cost-effectiveness analysis will determine the relative costs and benefits of the nurse-led model on the prescribing rates of LARC and medical abortion compared to usual care. A realist evaluation will provide contextual information relevant to intervention implementation informing considerations for scale-up and sustainability.

Consequences

This trial has the potential to increase LARC uptake and access to medical abortion for women in rural and regional Australia by supporting practice nurses to work to their full scope of practice in delivering essential reproductive health care.

Submitted by:

Mridula Shankar

Funding acknowledgement:

This project is funded through the Australian government's Medical Research Future Fund Primary Health Care Research Grant