Can a nurse-led model of care improve rural and regional access to contraception and medical abortion?
In Australia, women living in rural areas are 1.4 times more likely to experience an unintended pregnancy than women living in metropolitan areas. This is mainly due to geographical isolation and very limited access to contraception and abortion services in rural areas. Access could be improved by expanding the role of nurses in the delivery of long-acting reversible contraception (implants and intrauterine devices) and medical abortion services in general practice.
The ORIENT Study is trialling a nurse-led model of care that can support the provision of long-acting reversible contraception and medical abortion services in rural general practices. Led by Professor Danielle Mazza, Head of Department of General Practice and Director of the SPHERE NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care, this innovative model of care addresses a key priority of the Australian government’s National Women’s Health Strategy 2020-2030 – increasing access to sexual and reproductive health care services, particularly in rural and remote areas. It also addresses the World Health Organization’s call to improve access to contraception and abortion services by allowing nurses to work to their full scope of care and share clinical caregiving responsibilities with doctors.
"Through the ORIENT study, we have a great opportunity to create and trial an innovative workforce solution that can address the issue of high rates of unintended pregnancy in rural and regional areas of Australia," Professor Danielle Mazza said. "Nurse-led models of care for contraception and abortion already exist in community health and family planning clinic settings in other countries, so it’s about time that we explore whether such a model can be integrated into general practice care here in Australia."
An important feature of the ORIENT Study is the co-design approach to the development of the nurse-led model of care. In June 2021, consumers, health professionals, policymakers and key stakeholders in women’s health participated in a workshop to help design a model that meets the needs and preferences of women, is based on the best available research evidence and can be integrated into the workflow of general practices.
Ms Jessica Moulton, a PhD candidate with SPHERE, has been overseeing the co-design process as part of her PhD project. "Co-designing health services ensures that patients and providers are at the forefront of the process to improve health care and service delivery. Through this workshop, we have developed a model of care that can be tailored to the needs of each individual general practice."
To increase the chances of success, the implementation of this model will be supported in three ways. Firstly, general practitioners will be provided online training to become certified prescribers of MS-2 Step (medication for inducing an abortion) and both general practitioners and practice nurses will be provided training on the insertion and removal of contraceptive implants. Secondly, educational outreach sessions on how to set up the nurse-led model of care will be delivered to participating general practices. Finally, general practitioners and practice nurses will be provided access to the AusCAPPS Network, a national online community that provides resources, training, and online clinical support and advice on how to provide long-acting reversible contraception and medical abortion in general practice.
"Lack of training and follow-up support are often cited as barriers to providing long-acting reversible contraception and medical abortion services in general practice, so we wanted to make sure that our model of care also included providing adequate support to set up this model," Professor Mazza said. "We want to create a sustainable solution that can substantially increase the number of health professionals who can provide these essential health services so that all women in Australia can have access to them regardless of where they live."
The ORIENT Study is a five-year trial that is funded by a Medical Research Future Fund Primary Health Care Research grant. The study is led by the SPHERE NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care in collaboration with The University of British Columbia, The University of Sydney, Centre for Excellence in Rural Sexual Health, Family Planning NSW, and University of Technology Sydney.
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