Objective Long-acting reversible contraception (LARC) is the most effective form of contraception but use in Australia is low. Uptake of LARC prescribing by early-career general practitioners (GPs) has important implications for community reproductive health. We aimed to investigate the prevalence and associations of Australian GP registrars’ LARC prescribing.
Methods A cross-sectional analysis of the Registrar Clinical Encounters in Training (ReCEnT) cohort study 2010–2017. GP registrars collected data on 60 consecutive consultations on three occasions during their training. The outcome factor was prescription of LARC (compared with non-LARC). A secondary analysis was performed with problems involving prescription of LARC (compared with other problems). Associations with patient, practice, registrar and consultation independent variables were assessed by univariate and multivariable logistic regression.
Results 1737 registrars recorded 5382 problems/diagnoses involving women aged 12–55 years in which contraception was prescribed. 1356 (25%) involved LARC. Significant multivariable associations of prescribing LARC included patient age (OR 2.85, 95% CI 3.17 to 3.74, for age 36–45 years compared with age 12–18 years), practice rurality - inner-regional (OR 1.47, 95% CI 1.22 to 1.79) and outer-regional/remote/very remote (OR 1.47 95% CI 1.15 to 1.87) compared with major cities, practices in areas of lower socioeconomic status (SES) (OR 0.93, 95% CI 0.91 to 0.96 for SES by decile), generating learning goals (OR 1.37, 95% CI 1.04 to 1.79), in-consultation assistance-seeking (OR 1.58, 95% CI 1.24 to 2.01), and the registrar having reproductive health-related postgraduate qualifications (OR 1.33, 95% CI 1.01 to 1.76).
Conclusions The prevalence of LARC prescribing by Australian GP registrars is higher than has been previously estimated in established GPs. Postgraduate qualifications in reproductive health are associated with prescribing LARC. Prescribing practice differs according to rurality and relative socioeconomic disadvantage.
- education and training
- intrauterine devices
- intrauterine systems
- long-acting reversible contraception
- general practice
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Twitter @RachelHT, @SalSweeney
Contributors PM, SM, MvD and KH were investigators on the initial ReCEnT study. RT devised the design of the substudy. AT, AD, KH, PM, KF and NS oversaw data collection. AT, EH and JH analysed the data. RT drafted the manuscript. PM supervised the study progress. SS provided intellectual input to the manuscript. All authors contributed to critical revision of the manuscript. All authors read and approved the manuscript prior to submission.
Funding During the data collection period 2010 to 2015, funding of the ReCEnT study was by the participating educational organisations: General Practice Training Valley to Coast, the Victorian Metropolitan Alliance, General Practice Training Tasmania, Tropical Medicine Training, and Adelaide to Outback GP Training Program. These organisations were funded by the Australian Department of Health. Since 2016, the ReCEnT study is funded by an Australian Commonwealth Department of Health Commissioned Research Grant, and supported by GP Synergy, the general practice Regional Training Organization for New South Wales and the Australian Capital Territory. GP Synergy is funded by the Australian Department of Health. This particular project is supported by the Royal Australian College of General Practitioners with funding from the Australian Government under the Australian General Practice Training (AGPT) Program. The funders had no role in study design, collection, management, analysis, and interpretation of data; writing of the report; and the decision to submit the report for publication.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.
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