Improving access to contraception : long-acting reversible contraception in primary care

Background The majority of unintended pregnancies are attributed to contraceptive failures from incorrect and inconsistent use. Long-Acting Reversible Contraception (LARCs) are highly effective in reducing unintended pregnancies, however, use of LARC is low in the United Kingdom (UK), and the intrauterine device (IUD) is the least used method in the UK. This thesis examines the impact of the pay for performance incentive on prescribing of long-acting reversible contraception in UK primary care, and also investigates the effectiveness of interventions to improve uptake of copper-IUD devices. Methods (1) Mixed-level logistic regression analysis of data from the UK Office of National Statistics ONS (2) Longitudinal data analysis of long-acting reversible contraception before and after the introduction of pay for performance in a sample of general practices across the UK (3) Cochrane systematic review on the effectiveness of interventions to improve the use of copper-IUD internationally. Results (1) Women who accessed their contraception from family planning clinics were more likely to use LARCs than those who accessed it from general practices. (2) Since pay for performance indicators on offering contraceptive information were implemented in 2009, the prescribing of LARCs has increased by 4% annually. This has resulted in 8700 more women being prescribed LARC at the practices included in this study. (3) Provision of contraceptive counselling and appointment and recall systems for IUD insertions was found to be effective in increasing uptake of copper-IUD, and the timing of counselling on pre- or post-natal patients was found to be important. Conclusions Uptake of more effective contraceptive methods such as LARCs was associated with financial incentives for contraceptive information provision in general practices. Provision of consistent and structured contraceptive counselling in primary care for women of reproductive age may improve the use of LARCs and should in turn reduce unintended pregnancies in the long-run.Open Acces