title: Increasing the uptake of long-acting reversible contraception in general practice: the Australian Contraceptive ChOice pRoject (ACCORd) cluster randomised controlled trial protocol.
abstract: The increased use of long-acting reversible contraceptives (LARCs), such as intrauterine devices and hormonal implants, has the potential to reduce unintended pregnancy and abortion rates. However, use of LARCs in Australia is very low, despite clinical practice guidance and statements by national and international peak bodies advocating their increased use. This protocol paper describes the Australian Contraceptive ChOice pRojet (ACCORd), a cluster randomised control trial that aims to test whether an educational intervention targeting general practitioners (GPs) and establishing a rapid referral service are a cost-effective means of increasing LARC uptake.
  
  
  
  The ACCORd intervention is adapted from the successful US Contraceptive CHOICE study and involves training GPs to provide 'LARC First' structured contraceptive counselling to women seeking contraception, and implementing rapid referral pathways for LARC insertion. Letters of invitation will be sent to 600 GPs in South-Eastern Melbourne. Using randomisation stratified by whether the GP inserts LARCs or not, a total of 54 groups will be allocated to the intervention (online 'LARC First' training and rapid referral pathways) or control arm (usual care). We aim to recruit 729 women from each arm. The primary outcome will be the number of LARCs inserted; secondary outcomes include the women's choice of contraceptive method and quality of life (Short Form Health Survey, SF-36). The costs and outcomes of the intervention and control will be compared in a cost-effectiveness analysis.
  
  
  
  The ACCORd study has been approved by the Monash University Human Research Ethics Committee: CF14/3990-2014002066 and CF16/188-2016000080. Any protocol modifications will be communicated to Ethics Committee and Trial Registration registry. The authors plan to disseminate trial outcomes through formal academic pathways comprising journal articles, nation and international conferences and reports, as well as using more 'popular' strategies including seminars, workshops and media engagements.
  
  
  
  ACTRN12615001346561.
authors.affiliation: Department of General Practice, Monash University, Notting Hill, Victoria, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
authors.affiliation: Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Central Clinical School, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Black
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Taft
authors.affiliation: Australian Research Centre for Sex, Health and Society (ARCSHS), La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Jayne
authors.identifier: 0000-0002-2885-5292
authors.initials: J
authors.lastname: Lucke
authors.affiliation: School of Public Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kevin
authors.initials: K
authors.lastname: McGeechan
authors.affiliation: Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney, New South Wales, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Haas
authors.affiliation: Department of General Practice, Monash University, Melbourne, Victoria, Australia.
authors.forename: Heather
authors.identifier: 0000-0002-5158-8006
authors.initials: H
authors.lastname: McKay
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Indiana University, Indianapolis, Indiana, USA.
authors.forename: Jeffery F
authors.initials: JF
authors.lastname: Peipert
mesh_terms: D001315:Australia; D002755:Choice Behavior; D002985:Clinical Protocols; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female; D003362:Cost-Benefit Analysis; D003376:Counseling; D005193:Family Planning Services; D005260:Female; D058006:General Practice; D058005:General Practitioners; D006728:Hormones; D006801:Humans; D007318:Inservice Training; D007434:Intrauterine Devices; D010342:Patient Acceptance of Health Care; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011788:Quality of Life; D012017:Referral and Consultation; D012107:Research Design
chemical_list: D003271:Contraceptive Agents, Female; D006728:Hormones
keywords: Cluster randomised controlled trial; Complex interventions; Contraception; Counselling; General Practitioners; Long Acting Reversible Contraceptives (LARCs)