Increasing the uptake of long-acting reversible contraception through family practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial 3-year follow-up

Increased 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. 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 Participants were patients of ACCORd family physicians, identified their gender as women, and that had not actively withdrawn from the ACCORd trial 12-month survey.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. 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). 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.