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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| Hauptverfasser: | , , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
United States
Elsevier Inc
01.10.2025
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| Schlagworte: | |
| ISSN: | 0002-9378, 1097-6868, 1097-6868 |
| Online-Zugang: | Volltext |
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| Zusammenfassung: | 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 Participants were patients of ACCORd family physicians who identified as women and had not actively withdrawn from the ACCORd trial 12-month survey.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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| Bibliographie: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 0002-9378 1097-6868 1097-6868 |
| DOI: | 10.1016/j.ajog.2025.03.020 |