The AusCAPPS Network: A community of practice to support the provision of long acting reversible contraception and medical termination of pregnancy in primary care

Name The AusCAPPS (The Australian Contraception and Abortion Primary Care Practitioner Support Network) Why Long-acting reversible contraception (LARC) utilisation rates by Australian women remains very low, despite guidelines recommending increased use (Richters et al 2016). General practitioners (GPs) and women continue to preference the oral contraceptive pill and there has been little utilisation of practice nurses and pharmacists to promote LARC uptake. In addition, expanding the numbers of primary care practitioners willing to provide early medical abortion (EMA) (using mifepristone followed by misoprostol to end an early pregnancy up to 9 weeks), which is a more accessible and less invasive option than surgical termination that can be provided in primary care settings, has proven challenging. Very few GPs provide these services (Black et al 2017) and there remains great inequity in access to EMA, particularly for young and rural and remote women (Shankar et al 2017). AusCAPPS will empower the primary care workforce to deliver best practice, evidence-based care to women of reproductive age who are trying to prevent or manage an unintended pregnancy. This project will increase the availability of LARC methods (i.e. intrauterine devices (IUDs) and implants) and access to safe, affordable EMA, including for women from the most vulnerable populations. What The AusCAPPS community of practice is an online network designed to connect and develop skills of GPs, PNs and CPs in LARC and EMA. Whilst the overall project will run for 3.5years, participant evaluation will be undertaken following 2 years engagement in the site. Modelled on a successful Canadian online community of practice (the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l’avortement)(CAPS_CPCA), the AusCAPPS community of practice will provide support for health professionals by helping them create networks and implement new models of care. CAPS-CPCA is an interactive online community of practice for health professionals who are interested in providing EMA. AusCAPPS was designed by the project team in conjunction with primary care and sexual health stakeholders, through a knowledge exchange workshop held in February 2021. Linking LARC and EMA together in AusCAPPS made sense as the provision of these services and the need for them are often linked, and resources supporting LARC and EMA are currently dispersed across numerous providers, making it difficult for busy practitioners to locate and identify them. Partners emphasised that making AusCAPPS specific to the issues of LARC and EMA would emphasise the importance of these issues, make AusCAPPS easily identifiable, and ensure that AusCAPPS provided focused attention to this area of real need. Who provided All CIs and AIs are investigators in the SPHERE CRE and, together, have a strong history of collaboration in women's sexual and reproductive health research over many years and have made significant contributions to clinical practice, advocacy, translation into practice and policy, and guideline development and implementation. CI Mazza has an outstanding track record of leading and delivering large collaborative projects with national and international partners and is an international leader in women's health in primary care and knowledge translation. She is CIA of the SPHERE CRE, a CI on two NHMRC trials and leads the general practice arms of two other NHMRC CREs and one NHMRC Dementia Team Research Grant. She has led or contributed to many GP guidelines and represents her discipline as a GP and women's health implementation expert on government and non- government committees. CI Norman, Canada's Chair of Family Planning Public Health Research brings her international networks and experience and skills in knowledge translation gained from her community of practice on EMA that resulted in policy changes and increased access to EMA. CI Black chairs RANZCOG's special interest group in sexual and reproductive health that sets national training standards in contraception and abortion. She brings extensive clinical, research and policy expertise to the project. CI Taft is a leading Australian translational researcher in the areas of unplanned pregnancy, reproductive rights and domestic violence and has led national, competitively-funded studies in primary care and emergency contraception. CI Bateson, Medical Director at Family Planning NSW, is a key national opinion leader in contraception and abortion who is actively involved in research and guideline and policy development. CI McGeechan is a highly experienced biostatistician and is actively involved in many women's health research projects. AI Goldstone, Medical Director at Marie Stopes Australia, has devoted his clinical career to the provision of pregnancy termination and contraceptive services, including the establishment of EMA in Australia. AI Tomnay is Director of the Centre for Excellence in Rural Sexual Health, which designs, implements, and evaluates programs aimed at improving sexual and reproductive health services in rural Victoria. She brings expertise in nurse-led models of care for EMA in rural primary care. How AusCAPPS is a multidisciplinary online platform created to support practice in LARC and EMA. Our nationally-focused project targets all practicing GPs, PNs and CPs working in metropolitan, regional and rural settings and amongst marginalised populations (including migrant and Aboriginal and Torres Strait Islander groups). When and How Much Participation in AusCAPPS will be based on practitioner availability therefore we cannot forecast participant engagement in AusCAPPS nor have requirements/expectations around this. However, a robust engagement plan has been developed to both track and follow up with practitioners on their engagement in AusCAPPS and keep them interested. AusCAPPS was launnched July 2021 and is actively recruiting participants until July 2022. However, the intervention’s duration will be until 2023. Tailoring Based on a practitioner needs analysis, a range of existing international and national patient and practitioner resources will be housed on the site. In addition, engagement and learning activities will be developed on AusCAPPS based on the needs analysis and input from experts in the field. These will include: • Case studies, quizzes, practice tips • Discussion of practice service set up advice and models of best practice • “Ask the expert” questions and answers • Regional level networking • Ability to assist General Practitioners (GPs) and Practice Nurses (PNs) to identify community pharmacists (CPs) who they can partner with to improve access to LARC and EMA • Regular emails/newsletters with items of interest • Webinars and podcasts • Polls that will posted from time to time asking the community for their views on what content is the most useful, what aspects of the platform are the most informative, and how AusCAPPS could be improved. Content on AusCAPPS will be reviewed by an expert advisory group and clinical experts will moderate the online content over the intervention period. Resources on AusCAPPS will be reviewed and updated frequently to make sure AusCAPPS material is current.