None listed
Conditions
Brief summary
Women who misuse alcohol and other drugs have low rates of contraceptive use and higher rates of pregnancies (including unplanned pregnancies) compared to the general population. Once pregnant, these women and their babies experience higher rates of adverse health outcomes such as preterm birth, low birth weight and adverse developmental and social outcomes. Our research aims to explore whether women in drug and alcohol treatment who do not wish to conceive will have better rates of contraceptive use when contraceptive services are integrated into drug treatment clinics, compared to standard care where women are referred to primary health care services for their contraceptive needs. With this model we seek to increase use of all contraceptive methods but particularly methods that do not require daily adherence such as injections, implants and intrauterine devices that are reversible but extremely reliable. These methods are known collectively as the long acting reversible contraceptive (LARC) methods. A pilot integrated contraceptive medical service will be introduced within a drug and alcohol clinical setting. We propose to evaluate this pilot, to determine whether integrated care is feasible, and if it is more effective in increasing the use of contraceptive methods and reducing unplanned pregnancy than the standard of care.
Interventions
A three month lead in period will measure the rate of uptake of contraception in the standard care scenario within a drug and alcohol treatment service. After 3 months, an integrated contraception clinic will be established and women invited to attend. All participants will be followed up at 12 months.
This integrated contraceptive clinic will employ a medical officer for one session every second week (0.05FTE). All doctors employed will be specifically trained and accredited in family planni
A three month lead in period will measure the rate of uptake of contraception in the standard care scenario within a drug and alcohol treatment service. After 3 months, an integrated contraception clinic will be established and women invited to attend. All participants will be followed up at 12 months. This integrated contraceptive clinic will employ a medical officer for one session every second week (0.05FTE). All doctors employed will be specifically trained and accredited in family planning and will offer women participants the range of contraceptive options as per standard care including condoms, pills and LARC methods. If a LARC method is chosen then standard care involves follow-up of patients with implants at 2 weeks and IUDs at 6 weeks post-insertion. Treatment will be delivered according to current clinical practice guidelines developed by family planning organisations across Australia. All women accessing the drug health service will be initially screened for eligibility by their treating multidisciplinary team who regularly undertake physical, mental and social health assessments on their clients. These clients will be invited to take part and will be referred to the research nurse who will obtain informed consent and conduct baseline interviews.
Sponsors
Dr Kirsten Black
Study design
Allocation
Non-randomised trial
Primary purpose
Prevention
Eligibility
Sex/Gender
All
Age
18 Years to 49 Years
Healthy volunteers
No
Inclusion criteria
a) female patient of the drug and alcohol service; b) aged between 18 and 49 years; c) heterosexually active as defined as any heterosexual activity within the past 12 months; d) currently using no contraception, using less reliable contraceptive methods (e.g. withdrawal, rhythm, condoms, oral contraceptive) or considering a change of method; e) expects to be available for follow-up at 12 months; f) able to provide informed consent, including unaffected by substance use (intoxicated or in withdrawal), and adequate English language to complete study procedures.
Exclusion criteria
a) women with serious mental or physical illness or disability likely to impact on capacity to complete study procedures or uptake of a contraceptive method; b) opposed to the use of contraception on religious or other grounds; c) women who are pregnant at the time; d) women who are planning a pregnancy.
Outcome results
None listed