Pathways to IUD and implant insertion in general practice: a secondary analysis of the ACCORd study

Abstract

Background Despite recommendations, long-acting reversible contraceptives (LARC) are not always offered as first-line contraceptives in general practice. This study aimed to describe pathways used by women for insertion of LARC. Methods This is a secondary analysis of data from the Australian Contraceptives ChOice pRoject (ACCORd), a cluster randomised controlled trial set in 57 general practices in Melbourne, Australia. We investigated whether an educational intervention for general practitioners (GPs) and a rapid LARC insertion clinic increased LARC uptake. The main outcome measures were the type of health service, location/provider of intrauterine device (IUD) insertion; time to insertion; and distance travelled for IUD insertion. Results During ACCORd, 149 women had LARC insertion. IUD training was reported by 37% of GPs, but only 12% inserted them. In contrast, 70% of GPs inserted implants and 95% of women accessed implant insertion through their own general practice. LARC rapid referral clinics were used by 52% (13/25) of intervention GPs, where 71% (41/56) of IUD insertions occurred in these clinics (but no implants). There was no difference in the mean time from referral to IUD insertion between women attending intervention and control GPs (mean days 37.6 vs 32.7; P = 0.61). GPs (including IUD inserters) used a variety of referral pathways for IUD insertion, including public and private clinics, and other GPs. Women travelled up to 90 km for IUD insertion. Conclusions Although implant insertion has been integrated into general practice, few GPs insert IUDs. Where the option exists for GPs to refer to a LARC rapid referral clinic, the majority of IUD insertions will take place there. Establishing a network of such clinics Australia wide may both increase IUD uptake and address the extensive need for GP training in IUD insertion.