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

Abstract

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.

Authors+Show Affiliations

School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia rachel.h.turner@newcastle.edu.au.School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia. NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia.Elermore Vale General Practice, Newcastle, New South Wales, Australia.School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia. NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia.School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia. CReDITSS, University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia.Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia. NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia.CReDITSS, University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia.Elermore Vale General Practice, Newcastle, New South Wales, Australia.Eastern Victoria General Practice Training, Melbourne, Victoria, Australia. Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.General Practice Training Tasmania, Hobart, Tasmania, Australia.School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia. NSW & ACT Research and Evaluation Unit, GP Synergy Ltd - Newcastle, Newcastle, New South Wales, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31964777

Citation

Turner, Rachel, et al. "Prevalence and Associations of Prescribing of Long-acting Reversible Contraception By General Practitioner Registrars: a Secondary Analysis of ReCEnT Data." BMJ Sexual & Reproductive Health, 2020.
Turner R, Tapley A, Sweeney S, et al. Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data. BMJ Sex Reprod Health. 2020.
Turner, R., Tapley, A., Sweeney, S., Davey, A., Holliday, E., van Driel, M., ... Magin, P. (2020). Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data. BMJ Sexual & Reproductive Health, doi:10.1136/bmjsrh-2019-200309.
Turner R, et al. Prevalence and Associations of Prescribing of Long-acting Reversible Contraception By General Practitioner Registrars: a Secondary Analysis of ReCEnT Data. BMJ Sex Reprod Health. 2020 Jan 21; PubMed PMID: 31964777.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prevalence and associations of prescribing of long-acting reversible contraception by general practitioner registrars: a secondary analysis of ReCEnT data. AU - Turner,Rachel, AU - Tapley,Amanda, AU - Sweeney,Sally, AU - Davey,Andrew, AU - Holliday,Elizabeth, AU - van Driel,Mieke, AU - Henderson,Kim, AU - Ball,Jean, AU - Morgan,Simon, AU - Spike,Neil, AU - FitzGerald,Kristen, AU - Magin,Parker, Y1 - 2020/01/21/ PY - 2019/01/08/received PY - 2019/12/12/revised PY - 2019/12/19/accepted PY - 2020/1/23/entrez KW - education and training KW - general practice KW - implants KW - intrauterine devices KW - intrauterine systems KW - long-acting reversible contraception JF - BMJ sexual & reproductive health JO - BMJ Sex Reprod Health N2 - 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. SN - 2515-2009 UR - https://www.unboundmedicine.com/medline/citation/31964777/Prevalence_and_associations_of_prescribing_of_long-acting_reversible_contraception_by_general_practitioner_registrars:_a_secondary_analysis_of_ReCEnT_data L2 - http://jfprhc.bmj.com/cgi/pmidlookup?view=long&pmid=31964777 DB - PRIME DP - Unbound Medicine ER -