The newly published ACCORd follow up study by Monash University's SPHERE Centre of Research Excellence will help address Australia's chronically low use of the most effective types of contraception, long acting reversible contraceptives (LARC), and high number of unintended pregnancies.
Australian LARC use sits around 11 per cent, compared to countries like Sweden, other parts of Europe and the United Kingdom, which have over 30 per cent use.
In Australia, one in four women experience an unintended pregnancy, and a third of those end in abortion. It is higher amongst women aged 18-32 years and those living in non-urban areas.
The ACCORd trial involved training GPs in contraceptive counselling and providing them with a rapid pathway to a LARC inserter. Results were published in 2020 and demonstrated much higher rates of LARC uptake in women attending these GPs.
The follow up study, published this month in the American Journal of Obstetrics and Gynecology checked in with the women after three years.
Of the original ACCORd trial, 75 per cent of participants agreed to take part in the follow-up study. At three years, the continuation rate of long-acting reversible contraception was 66 per cent, significantly higher than for non-LARC methods at 55 per cent.
Satisfaction with their method of contraception was higher among LARC users compared to oral contraceptive pill users.
LARC use at three years was also significantly higher among women attending the Intervention GPs (41 per cent) compared to 28 per cent in women attending control GPs.
Participants who consulted with the Intervention GPs experienced significantly fewer unintended pregnancies – 3.1 per cent compared to 6.3 per cent for participants who received regular advice– and also fewer abortions at 0.9 per cent compared to 3.6 per cent.
The Head of Monash University's Department of General Practice and SPHERE Director, Professor Danielle Mazza, said the ACCORd project has far reaching implications for contraception in Australia.
"The results demonstrate that GP training in contraceptive counselling and the opportunity to rapidly refer women for LARC insertion if GPs don't provide that service themselves has a long-term sustained impact on the continuation rate of LARC methods, and reduces the numbers of unintended pregnancies and abortion," Professor Mazza said.
"The ACCORd trial and follow up study has informed the Federal Government's recent announcement of additional LARC training centres of excellence, training opportunities and financial incentives for GPs and other primary care practitioners, and subsidies that significantly lower the cost for women to access these methods."
The ACCORd project, conducted by SPHERE, comprised two major studies:
- ACCORd Trial: A trial to train GPs in contraceptive counselling and provide rapid insertion of LARC devices – involving 57 GPs and 740 women. The results were published in 2020.
- ACCORd Follow-up Study: A three-year follow-up with women participants to assess their ongoing use of LARCs involving 75 per cent of the original group of women.
Read the full paper in American Journal of Obstetrics and Gynecology: "Increasing the uptake of long-acting reversible contraception through family practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomized controlled trial 3-year follow-up"
DOI: https://doi.org/10.1136/bmjopen-2019-035895
