Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice.
Mazza, D
Shankar, M
Botfield, JR
Moulton, JE
Chakraborty, SP
Black, K
Tomnay, J
Bateson, D
Church, J
Laba, T-L
Kasza, J
Norman, WV
- Publisher:
- BMJ PUBLISHING GROUP
- Publication Type:
- Journal Article
- Citation:
- BMJ Open, 2023, 13, (3), pp. e065137
- Issue Date:
- 2023-03-22
Open Access
Copyright Clearance Process
- Recently Added
- In Progress
- Open Access
This item is open access.
Full metadata record
Field | Value | Language |
---|---|---|
dc.contributor.author | Mazza, D | |
dc.contributor.author | Shankar, M | |
dc.contributor.author | Botfield, JR | |
dc.contributor.author | Moulton, JE | |
dc.contributor.author | Chakraborty, SP | |
dc.contributor.author | Black, K | |
dc.contributor.author | Tomnay, J | |
dc.contributor.author | Bateson, D | |
dc.contributor.author |
Church, J |
|
dc.contributor.author | Laba, T-L | |
dc.contributor.author | Kasza, J | |
dc.contributor.author | Norman, WV | |
dc.date.accessioned | 2023-11-07T04:32:38Z | |
dc.date.available | 2023-11-07T04:32:38Z | |
dc.date.issued | 2023-03-22 | |
dc.identifier.citation | BMJ Open, 2023, 13, (3), pp. e065137 | |
dc.identifier.issn | 2044-6055 | |
dc.identifier.issn | 2044-6055 | |
dc.identifier.uri | http://hdl.handle.net/10453/173199 | |
dc.description.abstract | INTRODUCTION: Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS: ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763). | |
dc.format | Electronic | |
dc.language | eng | |
dc.publisher | BMJ PUBLISHING GROUP | |
dc.relation.ispartof | BMJ Open | |
dc.relation.isbasedon | 10.1136/bmjopen-2022-065137 | |
dc.rights | info:eu-repo/semantics/openAccess | |
dc.subject | 1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences | |
dc.subject.classification | 32 Biomedical and clinical sciences | |
dc.subject.classification | 42 Health sciences | |
dc.subject.classification | 52 Psychology | |
dc.subject.mesh | Pregnancy | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Female | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Long-Acting Reversible Contraception | |
dc.subject.mesh | Nurse's Role | |
dc.subject.mesh | General Practice | |
dc.subject.mesh | Telemedicine | |
dc.subject.mesh | Abortion, Induced | |
dc.subject.mesh | Randomized Controlled Trials as Topic | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Abortion, Induced | |
dc.subject.mesh | Nurse's Role | |
dc.subject.mesh | Telemedicine | |
dc.subject.mesh | Pregnancy | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Female | |
dc.subject.mesh | Randomized Controlled Trials as Topic | |
dc.subject.mesh | General Practice | |
dc.subject.mesh | Long-Acting Reversible Contraception | |
dc.subject.mesh | Pregnancy | |
dc.subject.mesh | Humans | |
dc.subject.mesh | Female | |
dc.subject.mesh | Australia | |
dc.subject.mesh | Long-Acting Reversible Contraception | |
dc.subject.mesh | Nurse's Role | |
dc.subject.mesh | General Practice | |
dc.subject.mesh | Telemedicine | |
dc.subject.mesh | Abortion, Induced | |
dc.subject.mesh | Randomized Controlled Trials as Topic | |
dc.title | Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice. | |
dc.type | Journal Article | |
utslib.citation.volume | 13 | |
utslib.location.activity | England | |
utslib.for | 1103 Clinical Sciences | |
utslib.for | 1117 Public Health and Health Services | |
utslib.for | 1199 Other Medical and Health Sciences | |
pubs.organisational-group | /University of Technology Sydney | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health | |
pubs.organisational-group | /University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation | |
pubs.organisational-group | /University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation | |
utslib.copyright.status | open_access | * |
dc.date.updated | 2023-11-07T04:32:36Z | |
pubs.issue | 3 | |
pubs.publication-status | Published online | |
pubs.volume | 13 | |
utslib.citation.issue | 3 |
Abstract:
INTRODUCTION: Women living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS: ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).
Please use this identifier to cite or link to this item:
Download statistics for the last 12 months
Not enough data to produce graph