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Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial protocol
  1. Danielle Mazza1,
  2. Kirsten Black2,
  3. Angela Taft3,
  4. Jayne Lucke4,
  5. Kevin McGeechan5,
  6. Marion Haas6,
  7. Heather McKay7,
  8. Jeffery F Peipert8
  1. 1Department of General Practice, Monash University, Notting Hill, Victoria, Australia
  2. 2Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Central Clinical School, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
  3. 3Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
  4. 4Australian Research Centre for Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Victoria, Australia
  5. 5School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  6. 6Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney, New South Wales, Australia
  7. 7Department of General Practice, Monash University, Melbourne, Victoria, Australia
  8. 8Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
  1. Correspondence to Professor Danielle Mazza; Danielle.Mazza{at}monash.edu

Abstract

Introduction The increased use of long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormonal implants, has the potential to reduce unintended pregnancy and abortion rates. However, use of LARCs in Australia is very low, despite clinical practice guidance and statements by national and international peak bodies advocating their increased use. This protocol paper describes the Australian Contraceptive ChOice pRojet (ACCORd), a cluster randomised control trial that aims to test whether an educational intervention targeting general practitioners (GPs) and establishing a rapid referral service are a cost-effective means of increasing LARC uptake.

Methods and analysis The ACCORd intervention is adapted from the successful US Contraceptive CHOICE study and involves training GPs to provide ‘LARC First’ structured contraceptive counselling to women seeking contraception, and implementing rapid referral pathways for LARC insertion. Letters of invitation will be sent to 600 GPs in South-Eastern Melbourne. Using randomisation stratified by whether the GP inserts LARCs or not, a total of 54 groups will be allocated to the intervention (online ‘LARC First’ training and rapid referral pathways) or control arm (usual care). We aim to recruit 729 women from each arm. The primary outcome will be the number of LARCs inserted; secondary outcomes include the women's choice of contraceptive method and quality of life (Short Form Health Survey, SF-36). The costs and outcomes of the intervention and control will be compared in a cost-effectiveness analysis.

Ethics and dissemination The ACCORd study has been approved by the Monash University Human Research Ethics Committee: CF14/3990-2014002066 and CF16/188-2016000080. Any protocol modifications will be communicated to Ethics Committee and Trial Registration registry. The authors plan to disseminate trial outcomes through formal academic pathways comprising journal articles, nation and international conferences and reports, as well as using more ‘popular’ strategies including seminars, workshops and media engagements.

Trial registration number ACTRN12615001346561.

  • Long Acting Reversible Contraceptives (LARCs)
  • Contraception
  • Counselling
  • General Practitioners
  • Cluster randomised controlled trial
  • Complex interventions

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors DM has led the development of this proposal. DM, KB, AT, JL, KM, MH and JFP were involved with developing the study protocol, design (adapted from the US Contraceptive CHOICE study) and funding proposal. KM provided the support for the development of the statistical analyses plan. DM, KB, AT, JL, KM, MH, HM and JFP have been involved with reviewing and editing the manuscript and have read and approved the final version.

  • Funding ACCORd is funded by the National Health and Medical Research Council—NHMRC grant ID: 1081743.

  • Competing interests None declared.

  • Ethics approval Ethics approval and consent to participate phase 1 of the study (the recruitment and training of GPs) and phase 2 of the study (the recruitment of women) have been approved by the Monash University Human Research Ethics Committee: CF14/3990-2014002066 and CF16/188-2016000080.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided appropriate credit and citation is given to the original authors and the source, use is non-commercial, a link to the Creative Commons license is provided, and if changes were made this is indicated. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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