General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision

Mazza, Danielle; Seymour, J; Sandhu, Monisha Vaid; Melville, Catriona; Brien, Jacquie O Rsquo; Thompson, Terri-Ann

doi:10.1071/py20297

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…Other studies in rural Australia have focused on women's experiences of abortion services once reached and the perspective of service providers about the delivery of care, including provision via telehealth (Doran and Hornibrook 2016;Dawson et al 2017;Hulme-Chambers et al 2018;Fix et al 2020;Ireland et al 2020;Cashman et al 2021;Mazza et al 2021;Malatzky and Hulme 2022). These studies have also found results similar to ours, that multiple systemic challenges exist for rural women when accessing services.…”

Section: Discussionsupporting

confidence: 79%

“…In a study examining access, equity and costs of induced abortion in Australia, the strongest predictor of late presentation (beyond 9 weeks) was living ≥4 h from the abortion clinic (Shankar et al 2017). Access barriers are well documented in relation to abortion care in Australia (Dawson et al 2017;Hulme-Chambers et al 2018;Fix et al 2020;Ireland et al 2020;Cashman et al 2021;Mazza et al 2021); however, little is known about the role of local generalist primary care providers in rural settings as the first point of contact for women seeking advice or services for unintended pregnancies.…”

Section: Introductionmentioning

confidence: 99%

“…The subsidisation of the combined mifepristone and misoprostol medication (MS 2 Step) under the Pharmaceutical Benefits Scheme (PBS) has enabled expansion of early medical abortion (Dawson et al 2017). The availability of medical abortion through primary care (and more recently at-home telehealth services) is being recognised as an important way to reduce inequity of access to abortion services (Mazza et al 2021). As a result, primary care providers are more involved than ever before in supporting women managing unintended pregnancy.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales

Noonan

Black

Luscombe

et al. 2022

Aust. J. Prim. Health

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Background. Under the generalist model of health care in rural Australia, general practitioners (GPs) are often the first point of contact for women seeking health services for unintended pregnancy, including pregnancy decision-making support and options advice, antenatal or abortion care. Rural women are more likely to experience unintended pregnancy in Australia, yet little is known about how well local rural primary healthcare services currently meet their needs. Methods. To address this gap, this qualitative study explores through in-depth semistructured interviews, the experiences of 20 rural women managing an unintended pregnancy, and their expectations of, and satisfaction with, the quality of care they received. The Framework Method was used to organise data and conduct an inductive thematic analysis. Results. Three themes related to management of unintended pregnancy in a rural primary care setting were identified: (1) women expect informed and efficient care once services are reached;(2) women desire greater choice and aftercare; and (3) comprehensive reproductive health should be part of rural primary care. Participants indicated an awareness of the limitations of the rural health system, yet a firm expectation that despite access delays, all of their reproductive health needs would be met. Choice, time efficiency, and aftercare were identified as gaps in the current primary care service experience. A desire for greater attention to rural reproductive health, including improved contraception, was also emphasised. Conclusions. Rural women with unintended pregnancy experienced gaps in service quality and described a lack of womancentred care in their local rural health setting. This study offers insight into how rural primary care providers can better support women to make decisions about and reach their preferred services for unintended pregnancy.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales

Noonan

Black

Luscombe

et al. 2022

Aust. J. Prim. Health

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“…This innovative approach to consumer and health professional engagement will ensure that the ORIENT intervention addresses consumer needs, is evidence-based, feasible, sustainable and offers the best chance of success. Through our extensive research, we have gathered patient and provider experience5 43–46 and systematically reviewed the literature 21. We have been able to understand the lived experience and patient journeys of consumers through audits of existing nurse-led models of care in community health and family planning settings22 and a large RCT of online education and rapid referral to LARC insertion 36.…”

Section: Methods and Analysesmentioning

confidence: 99%

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

Shankar²,

Botfield³

et al. 2023

BMJ Open

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IntroductionWomen 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 analysisORIENT 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 disseminationEthics 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 numberThis trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).

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“…Several articles deal with the importance of knowledge and attitudes in influencing access to care and outcomes for people, as well as reporting on interventions to address these. Mazza et al (2021) report on a qualitative study of general practitioners' understanding and engagement with telehealth-at-home abortion providers. Parker and colleagues (2021) investigate the attitudes of health professionals to an online support tool for carers of people at the end of their lives.…”

mentioning

confidence: 99%

Reflecting on 2021 for the Australian Journal of Primary Health

Harris‐Roxas¹,

Lewis²,

Macmillan³

2021

Aust. J. Prim. Health

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The past year has been a difficult one for health services and systems, including primary health care; arguably the most challenging in the post-war era. The COVID-19 pandemic has continued to dominate everyone's lives, and publication of this issue of the Australian Journal of Primary Health (AJPH) coincides with the second anniversary of the second documented case of COVID-19 in a human. This year has been characterised by a shift from 2020s' uncertainty and a lack of knowledge, to a better understanding of how COVID-19 is transmitted, the spread of new variants of concern, a rapid population-wide vaccination rollout, and COVID-19 becoming endemic. Primary health care mobilised on an unprecedented scale, as a workforce and as a system, to respond to these changes. Community-based health services have had an essential role proactively engaging with diverse communities and consumers to encourage testing and vaccination.The past year has also seen significant changes in academic publishing. There has been an emphasis on rapid dissemination of research findings during the pandemic, increasing the prominence of pre-publication manuscripts and reinforcing the need for timely peer review. There has been a significant increase in the volume of manuscripts submitted, including to the AJPH.At the same time, it is more difficult than ever to find peer reviewers for submitted articles. There has been a significant increase in the pressures on people's time, through their paid jobs, but also because of juggling caring responsibilities during multiple lockdowns. Many people have been redeployed to support health systems and organisations to respond to the COVID-19 pandemic. The Australian Government's decision to not provide any financial support to universities during the pandemic has led to thousands of jobs being lost across the sector over the past year, with more losses likely to come. Precarious employment has become even more entrenched and fewer people are in jobs that include service to the profession as part of their roles. This leads to fewer people being able to undertake reviews at the time we need high-quality peer review most.However, there are causes for hope. CSIRO Publishing has considerably extended and expanded its Read & Publish agreements (CAUL 2021; CSIRO Publishing 2021). From next year, AJPH joins these Read & Publish agreements, meaning Open Access publication without author publication charges to researchers at participating institutions. Corresponding authors from these institutions do not need to do anything, as eligibility will be flagged post-acceptance based on their email address or Ringgold ID. With a growing number of agreements in place, we hope this will make a major contribution to enhancing the accessibility of primary healthcare research to researchers, practitioners, and the public.

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General practitioner knowledge of and engagement with telehealth-at-home medical abortion provision

Cited by 8 publications

References 21 publications

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales

What women want from local primary care services for unintended pregnancy in rural Australia: a qualitative study from rural New South Wales

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

Reflecting on 2021 for the Australian Journal of Primary Health

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