Caroline Harvey

Australian women need increased access to long-acting reversible contraception

The Medical Journal of Australia ISSN: 0025-729X 2 September 2013 199 5 317-318 ©The Medical Journal of Australia 2013 www.mja.com.au Perspective contraceptive methods that, to optimise success, require women to make a daily decision to use them.5 Interventions such as enhanced counselling and instituting immediate start of the contraceptive pill have not consistently improved regularity of use and continuation rates or reduced the occurrence of unintended pregnancies. Adolescents and young women are especially vulnerable to unintended pregnancy, as 1 Co us Kirsten I Black Increased access could decrease unintended pregnancies and their associated costs

Ease of intrauterine contraceptive device insertion in family planning settings.

Intrauterine devices (IUDs) provide highly effective contraception for women worldwide. Reluctance to insert IUDs in the primary care setting may relate to concern about potential difficulty and complications, particularly in nulliparous women.

Chlamydia testing and retesting patterns at family planning clinics in Australia.

INTRODUCTION National guidelines recommend opportunistic chlamydia screening of sexually active 16- to 29-year-olds and encourage retesting 3-12 months after a diagnosed chlamydia (Chlamydia trachomatis) infection. We assessed chlamydia testing patterns at five Australian family planning clinics (FPCs). METHODS Using routine clinic data from 16- to 29-year-olds, we calculated chlamydia testing and positivity rates in 2008-2009. Reattendance, retesting and positivity rates at retesting within 1.5-4 and 1.5-12 months of a positive result were calculated. RESULTS Over 2 years, 13?690 individuals aged 16-29 years attended five FPCs (93% female). In 2008, 3159 females (41.4%,) and 263 males (57.0%) were tested for chlamydia; positivity was 8% and 19%, respectively. In 2009, 3178 females (39.6%) and 295 males (57.2%) were tested; positivity was 8% and 23%, respectively. Of 7637 females attending in 2008, 38% also attended in 2009, of which 20% were tested both years. Within 1.5-4 months of a positive test, 83 (31.1%) females reattended; the retesting rate was 13% and 12% retested positive. Within 1.5-12 months of a positive test, 96 (57.5%) females reattended; the retesting rate was 36% and 13% retested positive. CONCLUSIONS Approximately 40% of young people attending FPCs were tested for chlamydia but a smaller proportion were tested annually or were retested following chlamydia infection. High positivity rates emphasise that FPCs see a high-risk population. To maximise testing opportunities, clinical prompts, patient reminder systems and non-clinic testing strategies may be needed.

User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women

Copper intrauterine device (Cu‐IUD) use in Australia is low despite being a highly effective, cost effective non‐hormonal contraceptive with reported 12‐month continuation rates of 85% compared to 59% for oral contraception.

Evaluation of Chlamydia Partner Notification Practices and Use of the “Let Them Know” Website by Family Planning Clinicians in Australia: Cross-Sectional Study

Background Chlamydia, caused by Chlamydia trachomatis, is the most common reportable infection in many developed countries. Testing, treatment, and partner notification (PN) are key strategies for chlamydia control. In 2008 the Let Them Know (LTK) PN website was established, which provided means for people to send anonymous PN messages by text messaging (short message service, SMS), email, or letter. Objective We evaluated PN practices among Australian family planning clinicians following chlamydia diagnosis and assessed how often clinicians refer their patients to the LTK website. Methods A mixed methods approach included a Web-based cross-sectional survey of Australian family planning clinicians to examine PN attitudes and practices and focus groups to explore the context of LTK website use. Results Between May 2012 and June 2012, all clinicians from 29 different family planning services (n=212) were invited to complete the survey, and 164 participated (response rate=77.4%); of the clinicians, 96.3% (158/164) were females, 56.1% (92/164) nurses, and 43.9% (72/164) doctors. More than half (62.2%, 92/148) agreed that PN was primarily the clients responsibility; however, 93.2% (138/148) agreed it was the clinicians responsibility to support the client in informing their partners by providing information or access to resources. Almost half (49.4%, 76/154) of the clinicians said that they always or usually referred clients to the LTK website, with variation across clinics in Australian states and territories (0%-77%). Eleven focus groups among 70 clinicians at 11 family planning services found that the LTK website had been integrated into routine practice; that it was particularly useful for clients who found it difficult to contact partners; and that the LTK letters and fact sheets were useful. However, many clinicians were not aware of the website and noted a lack of internal clinic training about LTK. Conclusions The LTK website has become an important PN tool for family planning clinicians. The variation in referral of patients to the LTK website and lack of awareness among some clinicians suggest further promotion of the website, PN training, and clinic protocols are warranted.

Young people's perceptions of sexual and reproductive health in regional and rural Queensland: capturing the views of adolescents through reference groups and a user-friendly electronic survey

UNLABELLED Background Young people in regional and rural Queensland have difficulty accessing sexual and reproductive health (SRH) services. Young peoples views regarding barriers and enablers for accessing SRH services and markers of quality are largely unknown. METHODS Young peoples perceptions regarding SRH services are explored through a cross-sectional study via eight reference group meetings and an electronic survey in four sites: Atherton Tablelands, Rockhampton, Toowoomba and Townsville. The survey, developed in consultation with young people, was administered online and face to face using tablet computers. Data from 391 rural and regional participants was precoded for bivariate comparisons involving χ(2) and confidence interval (CI) tests. RESULTS The most valued markers of quality in SRH services defined by young people all related to staff characteristics. Young people preferred services where staff were friendly (87.3%; 95% CI: 83.8-90.8%), easy to talk to (91.4%; 95% CI: 88.5-94.3%), good listeners (95.4%; 95% CI: 93.2-97.6%) and did not judge them (90.5%; 95% CI: 87.4-93.6%). A model of SRH service delivery encompassed within general health services was highly valued by 58.9% (95% CI 53.7-64.1%). However, 36.2% (95% CI: 31.4-41.0%) preferred to seek care from SRH specialist services. CONCLUSIONS Service provision can be improved by training, and retaining friendly, attentive and non-judgemental staff. A model of service provision that includes general health care and provides sexual health services may increase the acceptability and accessibility of SRH services among youth. Additionally, our study highlights the need for choice between general and specialist SRH services.

Contraception: The contraceptive consultation

Introduction: The contraceptive consultation differs across international healthcare systems in relation to the setting, scope of practice, provider-responsibility and the available time frame. The service may range from a straightforward repeat contraceptive pill script for a medically well long-term user to more complex situations which require consideration of multiple factors. These include personal circumstances and preferences, the medical history, access to ongoing services and cost considerations. Contraceptive advice may be provided opportunistically or be part of a planned consultation and the patient may be well informed about her or his options or conversely have minimal or even no prior knowledge. Despite this variability, the basic principles which should be embedded in any consultation include an evidence-based approach to assessment, advice and service provision and a patient-centred approach to contraceptive choice, regardless of life stage. Role of the healthcare practitioner: The role of the healthcare practitioner is to take a relevant medical and social history from the patient (Box 8.1).he history underpins the provision of balanced and easily understood contraceptive information to assist the patient in making an individually tailored and safe choice. Providing evidence-based information about the wide range of options at the same time as responding to the patient’s individual needs can present a challenge to practitioners. The key to a successful consultation is to ensure that the patient leaves with their contraceptive needs met, either with the immediate provision of a contraceptive method or a plan for initiation at a specified future date. This chapter provides guidance on how to fulfil this outcome.