Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data

Abstract

ObjectiveLong-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.MethodsA 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.Results1737 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).ConclusionsThe 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.

Prescribing of long‐acting reversible contraception by general practice registrars across different rural regions of Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training Study data

“…A total of 1608 (97%) were Royal Australian College of GP trainees, 17 (1%) Australian College of Rural and Remote Medicine trainees and 23 (1%) joint fellowship. Further detailed participating registrar, practice and patient demographics are reported elsewhere 7 …”

“…Women living in rural regions are more likely to use LARC than those living in major cities 5 despite poorer access to services 6 . Previous research has shown that GP registrars prescribe LARC methods more than has been previously estimated in established GPs 7 . Furthermore, GP registrars prescribe LARC more in rural practice locations compared to major cities 7 .…”

“…Previous research has shown that GP registrars prescribe LARC methods more than has been previously estimated in established GPs 7 . Furthermore, GP registrars prescribe LARC more in rural practice locations compared to major cities 7 . Understanding the contraceptive needs of rural women is important since living in a rural area is significantly associated with unintended pregnancy 8 …”

Barriers to prescribing of long‐acting reversible contraception (LARC) by general practitioner registrars: A cross‐sectional questionnaire

“…16 The oral contraceptive pill is the most frequently prescribed method of contraception by established GPs 17 and we have previously found this prescribing pattern in GP registrars (vocational trainees in specialist general practice). 18 The training and behaviour of GP registrars is an important indicator of future primary care provision. Their vocational training period is a critical time for skill acquisition, including LARC insertion.…”

Time again for an organised approach to general practice research in New Zealand?

“…Currently the evidence supporting many general practice guidelines comes from research carried out in hospital settings. However, topics such as the management of impetigo, 2 urinary tract infections, 3 long acting contraception 4 and the use of dermoscopy 5 are infinitely more suitable subjects for general practice research. The ReCEnT data, having been collected by trainees, are also a rich source of information on the training needs of early career general practitioners (GPs).…”