ASM 2020 - prize winning presentation from AAAPC 2018

The Australian Contraceptive ChOice pRoject (ACCORd): A cluster randomised controlled trial aimed at increasing LARC uptake

Presenter: Danielle Mazza

Authors: Danielle Mazza, Cathy Watson, Kirsten Black, Jayne Lucke, Angela Taft, Kevin McGeechan, Marion Haas, Kathleen McNamee, Jeffrey Peipert

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 gynecologists 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.

Professor Danielle Mazza. Head, Department of General Practice Monash University. Presenting author

Dr Cathy Watson, Research fellow, Department of General Practice, Monash University

A Prof Kirsten Black. Joint Head of Discipline of Obstetrics, Gynaecology and Neonatology, University of Sydney

Professor Jayne Lucke. Director of the Australian Research Centre for Sex, Healht and Society (ARCSHS). La Trobe University

Professor Angela Taft. Professor and Principal Research Fellow at the Judith Lumley Centre, La Trobe University

Dr Kevin McGeechan. Senior Lecturer in Biostatistics at the School of Public Health, Public Health, School of Public Health University of Sydney

Professor Marion Haas. Professor of Health Economics, Centre for Health Economics Research and Evaluation, University of Technology Sydney

Dr Kathleen McNamee, Medical Director, Family Planning Victoria

Professor Jeffrey Peipert, Clarence E. Ehrlich Professor and Chair of Obstetrics and Gynecology, Indiana University School of Medicine