June 2025
GP intervention increases long-acting reversible contraceptive continuation rate
By Rebecca Jenkins
A GP-based intervention increases the rate of long-acting reversible contraception (LARC) continuation and reduces unintended pregnancies and abortions, an Australian longitudinal study finds.
LARC methods, such as hormonal intrauterine devices (IUDs) and contraceptive implants, were the most effective form of reversible contraception and their increased use was known to reduce the rate of unintended pregnancies and abortions, researchers wrote in the American Journal of Obstetrics & Gynecology. Yet it was estimated only 10.8% of women in Australia aged 15 to 44 years were currently using LARCs, compared with 35% in Denmark and 14.3% in the UK.
Researchers from Monash University’s SPHERE Centre of Research Excellence, Melbourne, designed the Australian Contraceptive ChOice pRoject (ACCORd) randomised controlled trial to assess the effects of training GPs to deliver structured counselling on all available contraceptive methods, with a focus on efficacy and safety.
Doctors in the intervention arm were also given access to an online booking system for rapid referral to LARC insertion clinics.
The original trial involved 57 GPs in metropolitan Melbourne general practices, with 25 recruited to the intervention arm and 32 to the control arm, where they offered usual care.
Initial results were published in 2020 and showed significantly higher LARC insertion rates among patients of GPs in the intervention group than in the control group at four weeks, with this outcome sustained at six months and 12 months.
To assess the long-term impact of the intervention, the researchers invited women from the original trial to take part in a follow-up survey at three years, with 75% of the original participants agreeing to participate.
The researchers found the rate of continuation of LARC at three years was 66%, significantly higher than the 55% rate observed with non-LARC methods.
Satisfaction with the method of contraception was also higher among LARC users than among oral contraceptive pill users.
LARC use at three years was significantly higher among women attending the intervention GPs (41%) compared with women attending GPs in the control arm (28%).
Women who had been counselled by a GP in the intervention group experienced significantly fewer unintended pregnancies compared with women from the control group (3.1%. vs 6.3%) and the same trend was seen with abortions (0.9% vs 3.6%).
Lead author, Professor Danielle Mazza, Head of the Department of General Practice at Monash University and Director of SPHERE, said the results showed the intervention had a sustained impact on the continuation rate of LARC methods and the number of unintended pregnancies and abortion.
‘The main take home message from the findings for GPs is that contraceptive counselling should involve an effectiveness-based approach,’ she told Medicine Today.
‘Starting by talking about the most effective forms of contraception first leads to increased uptake of IUD and implants in the short and long term and decreased rates of unplanned pregnancy and abortion.’
Professor Mazza said the study findings had informed recent Federal Government policy to offer scholarships for primary care practitioners to train in IUD insertion, as well as support for increased availability of IUD and implant insertion training and new centres of LARC excellence in each state and territory.
For further support, Professor Mazza pointed GPs towards the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS), which provides evidence-based information and support to primary care practitioners in initiating and delivering both LARC and medical abortion (https://medcast.com.au/communities/auscapps).
Am J Obstet Gynecol; 2025: doi.org/10.1016/j.ajog.2025.03.020.