A nurse‐led model of care to improve access to contraception and abortion in rural general practice: Co‐design with consumers and providers

Author:

Moulton Jessica E.12ORCID,Arefadib Noushin12ORCID,Botfield Jessica R.123ORCID,Freilich Karen12,Tomnay Jane4,Bateson Deborah5ORCID,Black Kirsten I.6ORCID,Norman Wendy V.78ORCID,Mazza Danielle12ORCID

Affiliation:

1. SPHERE, NHMRC Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care Melbourne Victoria Australia

2. Department of General Practice, School of Public Health and Preventive Medicine Monash University Melbourne Victoria Australia

3. Family Planning NSW Sydney New South Wales Australia

4. Centre for Excellence in Rural Sexual Health University of Melbourne Melbourne Victoria Australia

5. Daffodil Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia

6. Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia

7. Department of Family Practice University of British Columbia Vancouver British Columbia Canada

8. Faculty of Public Health and Policy, Public Health, Environments & Society London School of Hygiene and Tropical Medicine London UK

Abstract

AbstractAimTo describe key features of a co‐designed nurse‐led model of care intended to improve access to early medication abortion and long‐acting reversible contraception in rural Australian general practice.DesignCo‐design methodology informed by the Experience‐Based Co‐Design Framework.MethodsConsumers, nurses, physicians and key women's health stakeholders participated in a co‐design workshop focused on the patient journey in seeking contraception or abortion care. Data generated at the workshop were analysed using Braun and Clarkes' six‐step process for thematic analysis.ResultsFifty‐two participants took part in the co‐design workshop. Key recommendations regarding setting up the model included: raising awareness of the early medication abortion and contraceptive implant services, providing flexible booking options, ensuring appointment availability, providing training for reception staff and fostering good relationships with relevant local services. Recommendations for implementing the model were also identified, including the provision of accessible information, patient‐approved communication processes that ensure privacy and safety, establishing roles and responsibilities, supporting consumer autonomy and having clear pathways for referrals and complications.ConclusionOur approach to experience‐based co‐design ensured that consumer experiences, values and priorities, together with practitioner insights, were central to the development of a nurse‐led model of care.Implications for the Profession and/or Patient CareThe co‐designed nurse‐led model of care for contraception and medication abortion is one strategy to increase access to these essential reproductive health services, particularly in rural areas, while providing an opportunity for nurses to work to their full scope of practice.ImpactNurse‐led care has gained global recognition as an effective strategy to promote equitable access to sexual and reproductive healthcare. Still, nurse‐led contraception and abortion have yet to be implemented andevaluated in Australian general practice. This study will inform the model of care to be implemented and evaluated as part of the ORIENT trial to be completed in 2025.Reporting MethodReported in line with the Standards for Reporting Qualitative Research (SRQR) checklist.Patient or Public ContributionTwo consumer representatives contributed to the development of the co‐design methodology as members of the ORIENT Intervention Advisory Group Governance Committee.

Publisher

Wiley

Reference74 articles.

1. Person‐centred sexual and reproductive health: A call for standardized measurement

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3. American College of Obstetricians and Gynecologists. (2022).Patient‐centered contraceptive counseling. [Internet]. Committee on Health Care for Underserved Women Contraceptive Equity Expert Work Group and Committee on Ethics.https://www.acog.org/clinical/clinical‐guidance/committee‐statement/articles/2022/02/patient‐centered‐contraceptive‐counseling

4. Australian Institute of Health and Welfare. (2020).A profile of primary health care nurses Data. [Internet].https://www.aihw.gov.au/reports/primary‐health‐care/a‐profile‐of‐primary‐care‐nurses/data

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