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

被引：6

作者：

Mazza, Danielle ^{[1
]}

Shankar, Mridula ^{[1
]}

Botfield, Jessica R. ^{[1
]}

Moulton, Jessica E. ^{[1
]}

Chakraborty, Samantha Paubrey ^{[1
]}

Black, Kirsten ^{[2
]}

Tomnay, Jane ^{[3
]}

Bateson, Deborah ^{[4
]}

Church, Jody ^{[5
]}

Laba, Tracey-Lea ^{[5
,6
]}

Kasza, Jessica ^{[7
]}

Norman, Wendy, V ^{[8
,9
]}

机构：

[1] Monash Univ, Fac Med Nursing & Hlth Sci, Dept Gen Practice, Clayton, Vic, Australia

[2] Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia

[3] Univ Melbourne, Dept Rural Hlth, Melbourne, Vic, Australia

[4] Univ Sydney, Obstet Gynaecol & Neonatol, Sydney, NSW, Australia

[5] Univ Technol Sydney, Ctr Hlth Econ Res & Evaluat, Fac Hlth, Ultimo, NSW, Australia

[6] Univ South Australia, Clin & Hlth Sci, Adelaide, SA, Australia

[7] Monash Univ, Sch Publ Hlth & Prevent Med, Clayton, Vic, Australia

[8] Univ British Columbia, Dept Family Practice, Vancouver, BC, Canada

[9] London Sch Hyg & Trop Med, Fac Publ Hlth & Policy, Publ Hlth Environm & Soc, London, England

来源：

BMJ OPEN | 2023年 / 13卷 / 03期

关键词：

primary care; public health; quality in health care; PATIENT SATISFACTION; DISEASE MANAGEMENT; TELEMEDICINE; EXPERIENCES; PREGNANCY; SERVICES; IMPACT; SAFETY; WOMEN;

D O I：

10.1136/bmjopen-2022-065137

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页数：10

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