The Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network: A protocol for delivering and evaluating an online community of practice

Problem

Long-acting reversible contraception (LARCs), such as intrauterine devices (IUDs) and implants, are effective at preventing pregnancy but use amongst Australian women remains low. In the context of informed choice, general practitioners (GPs), practice nurses (PNs), and community pharmacists (CPs) could be instrumental in providing information and services to support choices such as LARC. However, uptake is limited by misperceptions, lack of public education, and lack of practitioner experience, practice systems, mentoring, and support. Similar issues prevent adequate availability of early medical abortion (EMA) where approximately 10% of GPs prescribe and fewer than 20% of pharmacists dispense EMA medication in Australia. Access to LARC and EMA services is particularly difficult in rural and remote areas.

Approach

To address these issues, the AusCAPPS study was developed to improve access to LARC and EMA in primary care in Australia. The primary objective is to establish, deliver and evaluate an innovative multidisciplinary online community of practice (the AusCAPPS Network) supporting GPs, PNs, and CPs to deliver LARC and EMA services. Secondary objectives are to increase the number of pharmacists certified to provide/dispense EMA and to increase GPs prescribing LARC and EMA.The AusCAPPS Network is a partnership between international and Australian researchers and stakeholders in contraception and abortion care. We will use mixed-methods to evaluate outcomes from this 3.5-year project: (a) a national pre- and post-intervention survey to undertake geo-mapping and understand service provision and identify gaps across the country, assess changes in the number of dispensers and prescribers, and knowledge and attitudes of participants; (b) health services data to assess changes in LARC and EMA prescriptions; and (c) a realist evaluation involving Google analytics and participant interviews to analyse how the intervention was received.

Findings

A knowledge exchange workshop with industry, professional, government, and non-government organisations was undertaken in February 2021 to identify key features for the AusCAPPS Network. Identified features included networking with peers and experts, a database of providers and dispensers of LARC and EMA services, a resource library, and links to LARC and EMA training providers. Clinical content to be included on AusCAPPS will undergo an iterative and ongoing review process informed by literature, input from expert clinicians, and feedback from governance committees whose membership comprises stakeholders in LARC and EMA service delivery. The AusCAPPS network and pre-intervention survey were both launched in July 2021. Outcome measurement will be undertaken at two years, in July 2023.

Consequences

We postulate that provision of mentorship, model practice systems, education materials, and peer and expert supports may increase clinician knowledge and confidence to prescribe or dispense LARC and EMA. This may offer women enhanced access to the full range of contraception and abortion options.