LARC uptake shows general practice investment ‘gets you results’

In Australia, one in four women experience an unintended pregnancy and about one in three of those pregnancies end in abortion.
 
However, the latest results of a longitudinal study may challenge what researchers call Australia’s ‘chronically low use’ of long-acting reversible contraceptives (LARCs).
 
The Australian Contraceptive ChOice pRoject (ACCORd) follow-up study, published this week, shows significant results on the efficacy and continuity of use of LARC among patients of GPs who received contraceptive counselling training and were provided with a rapid pathway to a LARC inserter.
 
Professor Danielle Mazza, Head of Monash University’s Department of General Practice and SPHERE Director, told newsGP the release of the study is ‘the culmination of over 10 years of work’.
 
‘This study really shows the long-term impact of the intervention, in terms of its capacity to reduce unplanned pregnancy, reduce abortion and increase continuation rates,’ she said.
 
The first stage in the ACCORd trial involved 57 GPs working in Melbourne practices, who were separated into 25 intervention and 32 control GPs.
 
The intervention GPs were trained in contraceptive counselling and provided with a rapid pathway to a LARC inserter. The results, published in 2020, demonstrated much higher rates of LARC uptake in women attending these GPs.
 
From the original ACCORd trial, 75% of participants took part in the follow-up study published this week.
 
It has shown that, at three years, the continuation rate of participants using LARC is 66%, compared to that for non-LARC methods at 55%.
 
Further, participants who consulted with the intervention GPs experienced significantly fewer unintended pregnancies – 3.1% compared to 6.3% for participants seen by control GPs – and fewer abortions, at 0.9% compared to 3.6%.
 
Satisfaction with their method of contraception was also higher among LARC users compared to oral contraceptive pill users.
 
Australian LARC use is about 11%, while some European countries and the United Kingdom have more than 30% use.
 
With an average efficacy rate of 99%, LARC is considered one of the most effective methods of contraception that does not require further interventions such as daily dosing or monthly administration, with the option of removal at any time.
 
An important feature of the ACCORd trial is training GPs to ‘rethink’ their approach to contraceptive counselling, to not only ensure all contraceptive options were mentioned, but to mention LARC first, said Professor Mazza.
 
‘It’s not to say that you’re pushing these products, but you’re just starting with the most efficacious ones,’ she said.
 
‘It’s an opportunity for women to hear more about them too, because a lot of women, particularly young women, come in and just say, “I want a script for the pill”.
 
‘All of this is trying to help women to access these contraceptive products, which are the most efficacious and which also assist in managing other conditions like dysmenorrhea, endometriosis and heavy menstrual bleeding.’
 
The latest ACCORd study findings were shared with the Federal Government earlier in the year, informing the $573 million women’s health package which was announced in February and matched by the Coalition.
 
Larger Medicare payments and more bulk billing for LARCs are a feature of the package, along with $25.1 million to establish eight LARC ‘centres for training excellence’ for GPs to send patients to, as well as providing training for GPs.
 
Professor Mazza said they will complement training scholarships announced in last year’s Federal Budget for primary care practitioners to receive LARC training.
 
‘We pointed out to the Government that it costs GPs to do the courses; not only the cost of the courses, but also the loss of income while doing the insertion training,’ she said.
 
Through SPHERE, Professor Mazza also directs AusCAPPS, an online community of practice for primary care practitioners around LARC and medical abortion.
 
‘It helps GPs to answer any curly clinical questions they might have around LARC, and it’s also got a whole lot of resources to support them in setting up their practice,’ she said.
 
Professor Mazza said she is ‘very proud’ that the ACCORd study is Australian research and has informed government policy and budget decisions.
 
‘I’m hoping that these results will again reach out to women to showcase the benefits of LARC,’ she said.
 
‘It’s a really good news story for general practice, because it shows that investing in general practice around this issue gets you results.’
 
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