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
Increased use of long-acting reversible contraception can reduce the rate of unintended pregnancies and abortions. This study aimed to assess whether the ACCORd (Australian Contraceptive ChOice pRoject) trial intervention resulted in sustained long-acting reversible contraception use and decreased u...
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| Veröffentlicht in: | American journal of obstetrics and gynecology Jg. 233; H. 4; S. 299.e1 - 299.e7 |
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01.10.2025
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| Abstract | Increased use of long-acting reversible contraception can reduce the rate of unintended pregnancies and abortions.
This study aimed to assess whether the ACCORd (Australian Contraceptive ChOice pRoject) trial intervention resulted in sustained long-acting reversible contraception use and decreased unplanned pregnancies.
This was a longitudinal 3-year follow-up study of the ACCORd cluster randomized controlled trial. The study setting was metropolitan Melbourne, Australia. Participants were patients of ACCORd family physicians who identified as women and had not actively withdrawn from the ACCORd trial 12-month survey. Family physicians in the intervention group undertook online training to deliver structured contraceptive counseling (nonbiased, scripted descriptions of all available contraceptive methods, with a particular focus on the efficacy and safety of each method), and were also provided access to an online booking system enabling rapid referral to long-acting reversible contraception insertion clinics. Family physicians in the control group provided usual care. Women who participated in the original ACCORd trial were invited to take part in a follow-up survey 3 years after completing their original baseline assessment. The primary outcome was the rate of continuation of long-acting reversible contraception methods compared with non–long-acting reversible contraception methods. The secondary outcomes included the contraceptive method used, satisfaction with contraceptive choice, and the number of unintended pregnancies and abortions.
Of the original ACCORd trial participants (N=531), 75% agreed to participate in the follow-up study. At 3 years, the rate of continuation of long-acting reversible contraception was 66%, significantly higher than the 55% rate observed with non-long-acting reversible contraception methods (P=.027). Satisfaction with the method of contraception was higher among long-acting reversible contraception users than among oral contraceptive pill users. A greater proportion of participants in the intervention group compared with the control group were still using a long-acting reversible contraception method 3 years after intervention (41% [93/229] and 28% [84/302], respectively; P=.019). Compared with the control group, women in the intervention group experienced significantly fewer unintended pregnancies (3.1% and 6.3%; odds ratio [95% confidence interval], 0.38 [0.16–0.86]; P=.021) and abortions (0.9% and 3.6%; odds ratio [95% confidence interval], 0.10 [0.02–0.50]; P=.0051).
The higher rates of long-acting reversible contraception continuation and the lower incidence of unintended pregnancies among women receiving care from ACCORd intervention family physicians at 3 years support scaling up the intervention. Policy and practice implications based on these findings suggest that the implementation of the ACCORd intervention should be considered in similar primary care systems and in contexts where long-acting reversible contraception uptake is low, free contraception is not feasible, and specific sexual and reproductive health services are not available or accessible. |
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| AbstractList | Increased use of long-acting reversible contraception can reduce the rate of unintended pregnancies and abortions.
This study aimed to assess whether the ACCORd (Australian Contraceptive ChOice pRoject) trial intervention resulted in sustained long-acting reversible contraception use and decreased unplanned pregnancies.
This was a longitudinal 3-year follow-up study of the ACCORd cluster randomized controlled trial. The study setting was metropolitan Melbourne, Australia. Participants were patients of ACCORd family physicians who identified as women and had not actively withdrawn from the ACCORd trial 12-month survey. Family physicians in the intervention group undertook online training to deliver structured contraceptive counseling (nonbiased, scripted descriptions of all available contraceptive methods, with a particular focus on the efficacy and safety of each method), and were also provided access to an online booking system enabling rapid referral to long-acting reversible contraception insertion clinics. Family physicians in the control group provided usual care. Women who participated in the original ACCORd trial were invited to take part in a follow-up survey 3 years after completing their original baseline assessment. The primary outcome was the rate of continuation of long-acting reversible contraception methods compared with non-long-acting reversible contraception methods. The secondary outcomes included the contraceptive method used, satisfaction with contraceptive choice, and the number of unintended pregnancies and abortions.
Of the original ACCORd trial participants (N=531), 75% agreed to participate in the follow-up study. At 3 years, the rate of continuation of long-acting reversible contraception was 66%, significantly higher than the 55% rate observed with non-long-acting reversible contraception methods (P=.027). Satisfaction with the method of contraception was higher among long-acting reversible contraception users than among oral contraceptive pill users. A greater proportion of participants in the intervention group compared with the control group were still using a long-acting reversible contraception method 3 years after intervention (41% [93/229] and 28% [84/302], respectively; P=.019). Compared with the control group, women in the intervention group experienced significantly fewer unintended pregnancies (3.1% and 6.3%; odds ratio [95% confidence interval], 0.38 [0.16-0.86]; P=.021) and abortions (0.9% and 3.6%; odds ratio [95% confidence interval], 0.10 [0.02-0.50]; P=.0051).
The higher rates of long-acting reversible contraception continuation and the lower incidence of unintended pregnancies among women receiving care from ACCORd intervention family physicians at 3 years support scaling up the intervention. Policy and practice implications based on these findings suggest that the implementation of the ACCORd intervention should be considered in similar primary care systems and in contexts where long-acting reversible contraception uptake is low, free contraception is not feasible, and specific sexual and reproductive health services are not available or accessible. Increased use of long-acting reversible contraception (LARC) can reduce the rate of unintended pregnancies and abortions.BACKGROUNDIncreased use of long-acting reversible contraception (LARC) can reduce the rate of unintended pregnancies and abortions.To assess whether the Australian Contraceptive ChOice pRoject (ACCORd) trial intervention resulted in sustained LARC use and decreasing unplanned pregnancies.OBJECTIVETo assess whether the Australian Contraceptive ChOice pRoject (ACCORd) trial intervention resulted in sustained LARC use and decreasing unplanned pregnancies.Longitudinal 3-year follow-up study of the ACCORd cluster randomised controlled trial. Study setting was metropolitan Melbourne, Australia. Participants were patients of ACCORd family physicians, identified their gender as women, and that had not actively withdrawn from the ACCORd trial 12-month survey. Intervention family physicians undertook online training to deliver structured contraceptive counselling (non-biased, scripted descriptions of all available contraceptive methods, with a particular focus on the efficacy and safety of each method) and were also given access to an online booking system enabling rapid referral to long-acting reversible contraception insertion clinics. Family physicians in the control group provided usual care. Women who participated in the original ACCORd trial were invited to take part in a follow-up survey three years after completing their original baseline assessment. The primary outcome was the continuation rate of use of long-acting reversible contraception methods compared with non-long-acting reversible contraception methods. Secondary outcomes included contraceptive method used, satisfaction with contraceptive choice, and the number of unintended pregnancies and abortions.STUDY DESIGNLongitudinal 3-year follow-up study of the ACCORd cluster randomised controlled trial. Study setting was metropolitan Melbourne, Australia. Participants were patients of ACCORd family physicians, identified their gender as women, and that had not actively withdrawn from the ACCORd trial 12-month survey. Intervention family physicians undertook online training to deliver structured contraceptive counselling (non-biased, scripted descriptions of all available contraceptive methods, with a particular focus on the efficacy and safety of each method) and were also given access to an online booking system enabling rapid referral to long-acting reversible contraception insertion clinics. Family physicians in the control group provided usual care. Women who participated in the original ACCORd trial were invited to take part in a follow-up survey three years after completing their original baseline assessment. The primary outcome was the continuation rate of use of long-acting reversible contraception methods compared with non-long-acting reversible contraception methods. Secondary outcomes included contraceptive method used, satisfaction with contraceptive choice, and the number of unintended pregnancies and abortions.75% of the original ACCORd trial participants (N=531) agreed to take part in the follow-up study. At three years, the continuation rate of long-acting reversible contraception was 66%, significantly higher than for non-long-acting reversible contraception methods at 55% (P=0.027). Satisfaction with their method of contraception was higher among long-acting reversible contraception users compared to oral contraceptive pill users. A greater proportion of participants in the intervention group as compared to the control group was still using a long-acting reversible contraception method three years post-intervention (41% (93/229) and 28% (84/302) respectively P=0.019). Compared to the control group, women in the intervention group experienced significantly fewer unintended pregnancies (3.1% and 6.3%; odds ratio (95% CI)=0.38 (0.16, 0.86), P=0.021) and abortions (0.9% and 3.6%; odds ratio (95% CI)=0.10 (0.02, 0.50), P=0.0051).RESULTS75% of the original ACCORd trial participants (N=531) agreed to take part in the follow-up study. At three years, the continuation rate of long-acting reversible contraception was 66%, significantly higher than for non-long-acting reversible contraception methods at 55% (P=0.027). Satisfaction with their method of contraception was higher among long-acting reversible contraception users compared to oral contraceptive pill users. A greater proportion of participants in the intervention group as compared to the control group was still using a long-acting reversible contraception method three years post-intervention (41% (93/229) and 28% (84/302) respectively P=0.019). Compared to the control group, women in the intervention group experienced significantly fewer unintended pregnancies (3.1% and 6.3%; odds ratio (95% CI)=0.38 (0.16, 0.86), P=0.021) and abortions (0.9% and 3.6%; odds ratio (95% CI)=0.10 (0.02, 0.50), P=0.0051).The higher long-acting reversible contraception continuation rates and fewer unintended pregnancies in women attending ACCORd intervention family physicians at three years supports a scale up. Policy and practice implications based on these findings are that the implementation of the ACCORd intervention should be considered in similar primary care systems and in contexts where long-acting reversible contraception uptake is low, free contraception is not feasible, and specific sexual and reproductive health services are either not available or accessible.CONCLUSIONThe higher long-acting reversible contraception continuation rates and fewer unintended pregnancies in women attending ACCORd intervention family physicians at three years supports a scale up. Policy and practice implications based on these findings are that the implementation of the ACCORd intervention should be considered in similar primary care systems and in contexts where long-acting reversible contraception uptake is low, free contraception is not feasible, and specific sexual and reproductive health services are either not available or accessible. BackgroundIncreased use of long-acting reversible contraception can reduce the rate of unintended pregnancies and abortions. ObjectiveThis study aimed to assess whether the ACCORd (Australian Contraceptive ChOice pRoject) trial intervention resulted in sustained long-acting reversible contraception use and decreased unplanned pregnancies. Study DesignThis was a longitudinal 3-year follow-up study of the ACCORd cluster randomized controlled trial. The study setting was metropolitan Melbourne, Australia. Participants were patients of ACCORd family physicians who identified as women and had not actively withdrawn from the ACCORd trial 12-month survey. Family physicians in the intervention group undertook online training to deliver structured contraceptive counseling (nonbiased, scripted descriptions of all available contraceptive methods, with a particular focus on the efficacy and safety of each method), and were also provided access to an online booking system enabling rapid referral to long-acting reversible contraception insertion clinics. Family physicians in the control group provided usual care. Women who participated in the original ACCORd trial were invited to take part in a follow-up survey 3 years after completing their original baseline assessment. The primary outcome was the rate of continuation of long-acting reversible contraception methods compared with non–long-acting reversible contraception methods. The secondary outcomes included the contraceptive method used, satisfaction with contraceptive choice, and the number of unintended pregnancies and abortions. ResultsOf the original ACCORd trial participants (N=531), 75% agreed to participate in the follow-up study. At 3 years, the rate of continuation of long-acting reversible contraception was 66%, significantly higher than the 55% rate observed with non-long-acting reversible contraception methods ( P=.027). Satisfaction with the method of contraception was higher among long-acting reversible contraception users than among oral contraceptive pill users. A greater proportion of participants in the intervention group compared with the control group were still using a long-acting reversible contraception method 3 years after intervention (41% [93/229] and 28% [84/302], respectively; P=.019). Compared with the control group, women in the intervention group experienced significantly fewer unintended pregnancies (3.1% and 6.3%; odds ratio [95% confidence interval], 0.38 [0.16–0.86]; P=.021) and abortions (0.9% and 3.6%; odds ratio [95% confidence interval], 0.10 [0.02–0.50]; P=.0051). ConclusionThe higher rates of long-acting reversible contraception continuation and the lower incidence of unintended pregnancies among women receiving care from ACCORd intervention family physicians at 3 years support scaling up the intervention. Policy and practice implications based on these findings suggest that the implementation of the ACCORd intervention should be considered in similar primary care systems and in contexts where long-acting reversible contraception uptake is low, free contraception is not feasible, and specific sexual and reproductive health services are not available or accessible. |
| Author | Black, Kirsten I. Assifi, Anisa R. McGeechan, Kevin Taft, Angela Haas, Marion Peipert, Jeffrey F. Mazza, Danielle Lucke, Jayne McNamee, Kathleen |
| Author_xml | – sequence: 1 givenname: Danielle orcidid: 0000-0001-6158-7376 surname: Mazza fullname: Mazza, Danielle email: danielle.mazza@monash.edu organization: SPHERE NHMRC Centre of Research Excellence, Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia – sequence: 2 givenname: Anisa R. orcidid: 0000-0001-5295-4074 surname: Assifi fullname: Assifi, Anisa R. organization: SPHERE NHMRC Centre of Research Excellence, Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia – sequence: 3 givenname: Kevin surname: McGeechan fullname: McGeechan, Kevin organization: School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia – sequence: 4 givenname: Marion surname: Haas fullname: Haas, Marion organization: Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, Australia – sequence: 5 givenname: Jeffrey F. surname: Peipert fullname: Peipert, Jeffrey F. organization: Department of Obstetrics, Midwifery, Gynecology and Reproductive Health, The University of Vermont Medical Center, Burlington, VT – sequence: 6 givenname: Jayne surname: Lucke fullname: Lucke, Jayne organization: Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, La Trobe University, Melbourne, Australia – sequence: 7 givenname: Angela surname: Taft fullname: Taft, Angela organization: Judith Lumley Centre, La Trobe University, Melbourne, Australia – sequence: 8 givenname: Kathleen surname: McNamee fullname: McNamee, Kathleen organization: Sexual Health Victoria, Box Hill, Australia – sequence: 9 givenname: Kirsten I. surname: Black fullname: Black, Kirsten I. organization: Royal Prince Alfred Hospital, Camperdown, Australia |
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| Keywords | unintended pregnancy family practice long-acting reversible contraception randomized controlled trial |
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This study aimed to assess whether the... BackgroundIncreased use of long-acting reversible contraception can reduce the rate of unintended pregnancies and abortions. ObjectiveThis study aimed to... Increased use of long-acting reversible contraception (LARC) can reduce the rate of unintended pregnancies and abortions.BACKGROUNDIncreased use of long-acting... |
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| SubjectTerms | Adolescent Adult Australia Contraception Behavior - statistics & numerical data Family Practice Female Follow-Up Studies Humans long-acting reversible contraception Long-Acting Reversible Contraception - statistics & numerical data Longitudinal Studies Obstetrics and Gynecology Pregnancy Pregnancy, Unplanned randomized controlled trial unintended pregnancy Young Adult |
| Title | 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 |
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