Sharon James, SPHERE Centre of Research Excellence Research Fellow and APNA Board Director (left image)
Lauren Coelli, Sexual Health Nurse and AusCAPPS Expert Clinical Content Lead (right image)
Nurses and midwives play a crucial role in providing sexual, maternity and reproductive health care for women. This role is expanding to include provision of long-acting reversible contraception (LARC) and medication abortion (MA). Have you considered incorporating LARC and MA care into your practice? We share some tips to help you get started.
The recent Australian Government Senate Inquiry into ‘Addressing barriers to sexual, maternity and reproductive healthcare in Australia’ has recommended implementation of important initiatives that will enhance the role of nurses and midwives in relation to LARC and MA.1 This includes increasing access to LARC training, new Medicare Benefits Schedule (MBS) items for LARC provision by nurse practitioners (NPs), expanded NP rights for ultrasound services supporting MA provision, state/territory legislative change to allow NPs and endorsed midwives to prescribe MA, Workforce Incentive Program – Practice Stream (WIP-PS) increases to support multidisciplinary care, and continued funding for the Australian Contraception and Abortion Primary Care Practitioner Support (AusCAPPS) Network.
In Australia, LARC and MA services are largely provided in primary health care settings, such as general practice or family planning organisations. These services are also mostly provided by general practitioners (GPs); however, increased provision by nurses and midwives would expand access to these services. This increased access to LARC and MA care would help resolve issues such as provider shortages, which can result in increased travel, costs and delays for women.
LARC (i.e., intrauterine devices [IUDs] and hormonal implants) are 99% effective and can be in place for 3–10 years depending on the method used. Despite their efficacy, LARC uptake in Australia remains relatively low at just 11%.
Around 26% of Australian women experience an unintended pregnancy, and 30% of these result in an abortion. MA is a safe and effective method of ending a pregnancy. It is approved for use in Australia for up to 9 weeks’ gestation and is available as a composite pack of mifepristone and misoprostol (called MS-2 Step).
Strengthening nursing and midwifery roles in LARC and MA care is in line with Australian and international recommendations to increase women’s access to sexual and reproductive health care.This approach enhances women’s access to contraceptive options and broadens the pool of qualified providers of LARC and MA care.
According to recent research, many general practice nurses (90%) believe their advice can influence women's contraceptive choices, yet few report inserting or removing IUDs (11%) or implants (16%). Similarly, few general practice nurses are involved in or manage MA services in their practice (9%). These general practice nurses also recognised that the benefits of providing MA in general practice included reducing women's need to travel (78%), increasing opportunities to provide contraceptive care at the same time (77%) and improving continuity of care (76%) (Figure 1).
Figure 1: Benefits of providing medication abortion in general practice: percentage of nurses agreeing with the statement. Figure reproduced from James et al.7 with permission.
In addition to this, many general practice nurses are interested in how to implement a LARC and MA service at their practice and are seeking clinical guidance on topics such as models of care, sharing care with the GP, and funding structures. If this applies to you, we have some suggestions for how to get started.
Implementing a LARC and MA service Nurses and midwives play a crucial role in enhancing women's access to LARC and MA provision in primary health care through nurse-/midwife-led models and shared care with others in the practice. The concept of sharing care aims to improve efficiency, access, and care quality by strategically redistributing tasks among different healthcare professionals.
To get started, draw on other nurse-led or shared-care models in place in primary health care settings, for example, chronic disease care planning, adult health checks or childhood immunisation provision. In these models, the patient is booked with both the nurse and the GP or NP. The nurse appointment is a long consult, and the GP or NP a short consult, either double booked at the end of the nurse consult, or straight after. The nurse takes the lead in providing information, gains informed consent, and completes a thorough, pre-determined patient assessment. When required, the GP or NP joins the consultation to complete their part of the assessment and provide scripts and/or requests for investigations, if required. In short, nurse-/midwife-led LARC and MA models of care work in the same way.
Planning for implementation is crucial. A good place to start is to consider how a patient would progress through your service and the development of a patient pathway or protocol. Here are some questions to consider:
1. Who will be involved in providing LARC and MA care in your service?
2. How do people access your service?
3. What do your appointment structures look like?
4. What are your referral pathways?
5. What funding model will be used?
On the AusCAPPS site, a resource library with guides is available to support practices in starting their own LARC and MA services. These guides provide all the information, clinical supports, and templates you could possibly need to start implementing these services at your practice. We encourage all nurses and midwives to consider expanding their practice to incorporate this important care. Doing so could significantly increase access and improve health outcomes for the women and pregnancy-capable people in your community!
Expand your practice in LARC and MA careAre you looking to support your own knowledge and practice in LARC and MA care? We encourage you to:
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Dr Sharon James is a Research Fellow (and former AusCAPPS Project Manager) at SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care (SPHERE CRE). She is also an experienced rural primary health care nurse and an APNA Board Director.
Lauren Coelli developed an interest in sexual health nursing whilst working in remote Aboriginal communities in the Northern Territory. She is passionate about increasing access to HIV, sexual health, contraceptive and abortion services in rural Australia through nurse-led models of care. Lauren is also an AusCAPPS Network expert clinical content lead.
The AusCAPPS Network is supported by the Austalian Government Department of Health, Disability and Ageing.
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