Community pharmacists can play a key role in the prevention and management of unintended pregnancy, including in the provision of counselling and by dispensing contraception, and for medication abortion (MA). However, Australian pharmacists’ practice and knowledge of effective contraceptive methods, including long-acting reversible contraception (LARC), is unknown, and few were registered to dispense MA at the time of the study. Our aim was to understand the knowledge, attitudes and practices of Australian community pharmacists in LARC and MA care. We conducted a cross-sectional national online survey of community pharmacists from July until October 2021. Participants were recruited through convenience sampling via mail and partner organisations’ emails, newsletters, and mailing lists. We used descriptive statistical analysis, including counts, proportions, Pearson’s chi-squared tests and Poisson regression for data analysis. Our descriptive survey forms part of the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS) mixed-methods project (ACTRN12622000655741). There were 533 eligible responses; 72

OBJECTIVES:To examine longitudinal trends in the provision of medication abortion (MA) in Australian general practice. STUDY DESIGN:Retrospective study of Australian females aged 14-49 years attending Australian general practices between 2014 and 2021. Data were sourced from the national general practice dataset, MedicineInsight. We calculated rates of MA provision and reported characteristics of those receiving and providing MA services. RESULTS:We identified 4306 instances of MA provision to 3980 unique individuals. The rate of MA provision increased from 0.11 per 1000 females in 2014/15 to 2.10 per 1000 females in 2020/21. A greater absolute increase in the rate of MA was evident among those aged 25-29 years, those residing in regional areas or those in areas of lower socioeconomic status. The proportion of general practices providing MA increased from 4.4% in 2014 to 22.7% in 2021. The proportion of general practices providing MA was higher among those located outside of major cities and in higher socioeconomic status areas. CONCLUSIONS:Despite modest increases in the rates of MA provision in general practice over time, less than one third of general practices provide MA. Significant geographical variation in MA provision is also evident according to remoteness, socioeconomic status and state/territory. The findings emphasise the need for additional initiatives to ensure equitable access to abortion care within the general practice setting, and future research should examine the underlying reasons for differences in MA uptake by patient characteristics and geographical location, informing targeted interventions and service planning.

Background A prominent barrier to broader intrauterine device (IUD) uptake is the fear of pain and discomfort associated with insertion of the device.Aim To examine the pain level perceived during IUD insertion and identify factors associated with perceived pain during the insertion procedure.Materials and Methods We conducted a secondary analysis of nationally representative survey data from Australian women using IUDs. We explored self-reported pain perception during IUD insertion retrospectively. We asked women about pregnancy history, mental health and their perceived knowledge about the IUD method they were using at the time of the survey. Ordinal logistic regression was employed to analyse associations between these factors and pain perception.Results A total of 347 respondents were using an IUD and reported on pain perception during IUD insertion. One in five women reported experiencing severe pain during IUD insertion and approximately one in two women reported experiencing mild or no pain during this procedure. Having a current mental health condition, having more than one previous pregnancy and higher self-perceived knowledge about IUD groups were associated with more perceived pain.Conclusions These findings highlight the need for healthcare providers to consider the complex interplay of factors affecting pain perception during IUD insertion, prioritise individualized pain management strategies and address perceived knowledge surrounding IUDs, particularly in women with mental health conditions. Exploring ways to improve the experience of women during IUD insertion may contribute to positive discourse around IUDs and to encourage others to select an IUD as a contraceptive approach.

OBJECTIVE:To examine geographical variation in utilisation of hormonal long-acting reversible contraceptives (LARCs), namely the hormonal intrauterine device (IUD) and implant. STUDY DESIGN:Cross-sectional study of Australian women aged 15-54 years using Pharmaceutical Benefits Scheme (PBS) dispensing data from 2018 to 2021. We calculated age-standardised rates of LARC dispensing per 1000 women across each Statistical Area Level 3 (SA3) according to remoteness and socioeconomic status (SES) indices. Differences between minimum and maximum rates of LARC utilisation in SA3s were used to determine magnitude of variation. RESULTS:Between 2018 and 2021, hormonal IUD dispensing rates increased from 18.4 to 21.6 per 1000 women in major cities, 25.2 to 30.6 per 1000 in inner regional, 25.4 to 28.7 per 1000 in outer regional, and 17.7 to 20.0 per 1000 in remote areas. This corresponded to decreases in implant dispensing rates from 14.6 to 12.6 per 1000 women in major cities, 25.3 to 23.1 per 1000 in inner regional, 28.0 to 25.3 per 1000 in outer regional, and 20.7 to 19.6 per 1000 in remote areas. Rates of LARC utilisation varied considerably across SA3s, ranging from 10.9 to 37.8 per 1000 women. Increasing SES was associated with increasing hormonal IUD rates in major cities (incidence rate ratio (IRR) 1.06, 95% CI 1.04 to 1.08), inner regional (IRR 1.06, 95% CI 1.03 to 1.09) and remote (IRR 1.44, 95% CI 1.12 to 1.85) areas, but decreasing implant rates in major cities (IRR 0.89, 95% CI 0.86 to 0.91) and inner regional areas (IRR 0.91, 95% CI 0.88 to 0.94). CONCLUSION:Given observed variation in LARC utilisation, efforts to identify and address barriers towards more equitable access to LARC methods appear warranted.

INTRODUCTION:The Primary Care Assessment Tool (PCAT) is designed to assess a patient's experience with primary care across various core and ancillary domains, including First contact - Utilization, First contact - Access, Ongoing Care, Coordination, Comprehensiveness (services provided), Family-centeredness, Community Orientation, and Cultural Competence. This study examined the psychometric properties of the Adult Primary Care Assessment Tool Short Form (PCAT-S) in the Australian general practice setting. METHOD:Data included 715 participants from the EQuIP-GP study, a cluster randomized controlled trial (RCT) conducted with adults aged 18-65 years with a chronic illness or aged over 65 years, from 34 general practices across Australia. For each subscale we assessed internal consistency using Cronbach's alpha. Factor structure of the PCAT-S instrument was assessed through confirmatory and exploratory factor analysis, using three samples with different methods for handling 'don't know/can't remember' responses. RESULTS:The findings were mixed. Specifically, the subscales related to First Contact - Utilization, Ongoing Care and Comprehensiveness, demonstrated satisfactory internal consistency. However, the remaining subscales showed weak internal consistency. Confirmatory factor analysis indicated potential model misspecification, while exploratory factor analysis generally supported the hypothesized factor structure, albeit with some observed deviations. CONCLUSIONS:The findings indicate the PCAT-S shows promise as an instrument to evaluate primary care experiences in Australia. However, the observed variability in internal consistency, along with issues identified in confirmatory and exploratory factor analyses, highlight the need for further validation and refinement in this population. Further research is required to address the identified limitations and enhance the tool's applicability within the Australian general practice context.

General practitioners (GPs) are central to the treatment and management of injured workers. Australian workers’ compensation funds GP consultations for work-related injuries. Almost all other GP consultations are subsidised by public healthcare insurance (Medicare Benefit Scheme). This study aimed to examine changes in publicly-insured GP consultations before and after injury for injured workers with long-duration claims, focusing on consultation duration types and GP-provided mental health and chronic diseases management plans. This retrospective cohort study using interrupted time series analysis included 3,755 injured workers and 10,113 community individuals with injury/index date between 2006 and 2016. We compared monthly changes in rates (per 1000 workers) of six GP consultation types for 12-month before and 24-months after injury. Acute and long-term changes were examined both overall (combining all consultation types) and separately by consultation type. Consultation types include four duration-based levels: A (0–6 min), B (6–20 min), C (20–40 min), and D (40–60 min), and two types describing mental health and chronic disease management plans. After injury, injured workers received an additional 1,600 Medicare-subsidised GP consultations per 1,000 workers per year compared to the community group. Post-injury, the largest increase in monthly consultation rates was observed for Level D consultations (IRR: 2.37, 95

ABSTRACT Background Guidelines on pre-pregnancy counselling are primarily clinical, and although recommendations and policy documents on preconception care exist in Australia, they place little or no emphasis on preconception health of adolescents and young adults. Objective To identify and prioritise unanswered questions and evidence uncertainties concerning preconception health needs of adolescents and young adults residing in Australia. Design Research priority exercise Setting and Participants Participants included young interest-holders (18-24 years) and professional interest-holders from the academics, healthcare, policy, community and government sectors residing in Australia. Methods We followed the James Lind Alliance (JLA) methodology to identify research priorities for preconception health of adolescents and young adults. The process was led by a multidisciplinary steering committee comprising young interest-holders and professional interest-holders (including academics and clinicians). A rapid literature review was conducted from which 80 research questions were developed across ten domains, which were refined through consultation and prioritised via two rounds of online surveys on Qualtrics using a 9-point Likert scale. Results The participants included 14 young interest-holders in each survey round, with 22 professional interest-holders in the first round and 33 in the second. Participants from across Australia participated in the survey, but most were from South Australia. In the first survey round, 28 questions across seven domains were prioritised by both professional and young interest-holders. This was followed by a reprioritisation exercise, resulting in the final top 10 research questions spanning five domains. The highest-priority research questions identified by the interest-holders concentrated in the domains of violence and mental health; early intervention and prevention; smoking, tobacco, alcohol, and substance use; access to preconception care and the healthcare system; and priority populations. Conclusion The study identified the top 10 priority research questions informed by professional and young interest-holders. It promotes new research and collaboration while offering guidance on future research investments and on designing preconception interventions for adolescents and young adults in Australia. Turning these priorities into research could improve the health outcomes for adolescents and their future generations.

Immigrant women can experience high rates of domestic violence and abuse (DVA) and migration trauma. Family or general practitioners (GPs) have limited DVA training or support to manage culturally competent DVA practice and associated trauma. The HARMONY study aimed to increase culturally competent DVA identification and referral among all, but especially migrant/refugee women from South-Asia, attending Australian GP clinics. Twenty-four GP clinics were recruited among two South-Asian communities in Northwest and Southeast Melbourne for a pragmatic cluster randomised controlled trial. Eligible clinics (i) employed ≥ 1 South-Asian GPs, (ii) used 1 of 2 electronic software programs, and (iii) agreed to anonymised, aggregated data extraction from computerised records. The intervention comprised (a) GP DVA educator and bilingual South-Asian DVA advocate co-delivering 4 h of online accredited culturally competent DVA training, and (b) 12 months follow-up support by the DVA advocate to intervention clinics. Comparison clinics offered routine care and were offered DVA training following the intervention’s completion. Investigators and statistician were blinded to allocation, but clinics and frontline staff were not. Aggregated, anonymised routine data were extracted for primary outcomes of DVA identification and referral at 12 and 15 months. Per-protocol adjusted, intention-to-treat analysis using Poisson regression. Five of 24 GP recruited clinics withdrew before the trial began due to COVID-19. At baseline, GPs recorded DVA in 0.6

Workers’ compensation claims processes may exacerbate mental health symptoms for individuals with work-related mental health conditions (WR-MHCs). This study examined associations between mental health outcomes and contemporaneous claim status. Data of this cohort study were drawn from 153 general practice patients with WR-MHCs providing 422 observations, enrolled in the IMPRovE trial across Australia. Workers’ compensation claim status (accepted, rejected, being assessed, or no claim), working status, and mental health outcomes (Depression Anxiety Stress Scale–21 (DASS-21) and Short-form health survey) were assessed via 3-monthly surveys. Mixed-effects linear regression models were used to assess the relationship between claim status and outcomes, adjusting for intervention status, working status, time-point, state, clinic size, location, age, and gender. On the DASS-21, patients with a claim application being assessed reported significantly poorer overall mental health outcomes than those with accepted claims (e.g. stress: β = 5.73, 95

BACKGROUND:Anti-Müllerian hormone (AMH) tests are often promoted as a measure of fertility; however, AMH adds limited predictive value beyond age alone for estimating the likelihood of live birth in couples trying to conceive. AIMS:This study aimed to examine longitudinal trends in the rate of AMH testing for fertility in the Australian general practice setting. MATERIALS AND METHODS:Retrospective open cohort study of 1,393,931 females aged 20-44 years attending Australian general practices between 2011 and 2021 using the national general practice database, MedicineInsight. Free text 'test reason' fields were examined to identify AMH tests ordered by General Practitioners for fertility assessment. We calculated age-standardised annual prevalence rates for AMH tests overall, as well as stratified by age group and concession card status. To examine between-practice variation, the intraclass correlation coefficient (ICC) was estimated using a two-level logistic regression model. RESULTS:The annual age-standardised prevalence of AMH test requests increased from 0.32 per 1000 females in 2011 to 4.33 per 1000 females in 2021. AMH testing was more common among those residing in a major city and of higher socioeconomic status, but less common among concession card holders. Following adjustment for patient case-mix, 21% (95% CI 18%-24%) of observed variation in AMH testing was attributable to differences between practices, with 45/423 (10.6%) of general practices having no patients with an AMH test. CONCLUSIONS:The noted substantial increase in clinical and consumer demand for AMH testing does not appear to be evidence-based, with substantial patient- and practice-level variation in testing evident.

Restrictions on social media access for users under 16 years raise a critical question about how adolescents in Australia will access sexual and reproductive health (SRH) information, especially where traditional systems often fall short. Social media has become an important source of SRH education, offering timely and relatable content that bridges gaps left by formal education and healthcare. As access to these platforms is restricted, other pathways must be strengthened. This includes investing in comprehensive in- and out-of-school sexuality education, youth-friendly primary care services and safe digital platforms designed with and for adolescents.

OBJECTIVES:Australia has commenced implementing contraceptive resupply and prescribing by community pharmacists to improve equity in method access. This study aimed to investigate pharmacist's acceptability of hormonal contraceptive resupply and prescribing. METHODS:Participants were recruited via convenience sampling and had provided contraceptive counseling consistent with the ALLIANCE intervention (i.e. structured, patient-centered, effectiveness-based care) to women seeking the emergency contraceptive pill or presenting prescriptions for medical abortion medicines. This qualitative descriptive study was embedded within the ALLIANCE trial, whose process evaluation included semi-structured interviews with pharmacist participants. The interview guide, containing questions on pharmacists' views of the resupply and prescribing service, was reviewed by the ALLIANCE Trial Chief Investigators and piloted in June 2024 with the SPHERE Pharmacy Advisory Circle. Thirteen questions were developed using the Theoretical Framework of Acceptability (TFA). Two researchers conducted line-by-line coding using an iteratively refined codebook, with codes mapped to TFA constructs to examine operationalization in pharmacists' delivery of hormonal contraception. KEY FINDINGS:Although pharmacists (n = 24) perceived that the service could be cost- and time-saving to patients, they raised concerns of unintentionally removing general practitioner (GP)-led monitoring of patients and overstepping GPs' roles. While pharmacists felt confident in their expertise and generally supported the service, they expressed hesitation about initiating contraceptive prescriptions, for which they felt further training and access to comprehensive medical records were required. Additional barriers included increased workload pressures, lack of reimbursement, and inadequate staffing. CONCLUSIONS:Overall, providing a resupply service appears to be acceptable to community pharmacists because it relies on the GP's initial assessment but prescribing less so. However, evaluation is needed post-implementation to explore sustainability, feasibility, and long-term impact on patient outcomes.

BACKGROUND:Reproductive coercion (RC) is a form of gender-based violence that interferes with reproductive autonomy. General practice is a key primary care setting where individuals, particularly women, access support for sexual and reproductive health (SRH). However, limited research explores how general practice clinicians recognise and respond to RC. We aimed to explore how general practitioners (GPs) and practice nurses (PNs) recognise and respond to RC in Australian general practice. METHODS:A qualitative descriptive study was conducted using semi-structured interviews with 10 GPs and 6 PNs. Interviews were conducted via Zoom, transcribed verbatim and analysed using inductive content analysis. RESULTS:Participants identified consultation-based 'red flags', including partner dominating the consult, patient discomfort, and disruptions in appointment or contraception use, that prompted RC inquiry. Participants proactively asked about RC in SRH consultations, tailoring questions to the context of contraception, pregnancy, or abortion care. Balancing safety, autonomy, and support was described as challenging, especially in cases involving adolescents or women with disabilities where carers or parents influenced patient consent. Participants described practical and patient-centred strategies, such as using telehealth consultations, discreet signals, covert care planning, and whole-of-practice team-based vigilance, to support women experiencing RC in general practice. CONCLUSIONS:Findings highlight how general practice clinicians in Australia recognise and respond to RC and can inform the development of clinical guidelines and practice approaches to strengthen recognition and response to RC in general practice.

INTRODUCTION:General practitioners (GPs) face challenges in diagnosing and managing work-related mental health conditions. In Australia, this prompted the development of a national clinical guideline (the Guideline) to support high-quality care. However, measuring the implementation of recommendations that require clinical judgment remains methodologically challenging. OBJECTIVE:This study describes an approach to developing and testing a guideline-specific tool to assess concordance with recommendations in the context of an implementation trial. METHODS:We used an exploratory sequential mixed methods design. Semi-structured interviews were conducted with 20 individuals with lived experience of work-related mental health conditions. The interview data informed personas and case studies, which were converted into 18 video vignettes simulating GP-patient consultations. Each vignette was mapped to a checklist of clinical indicators from the Guideline and paired with one multiple-choice and two short-answer questions. A scoring rubric (0-3 points per vignette) was developed and pilot-tested with three groups: GPs familiar with the Guideline, GPs unfamiliar with it, and medical/research students. Vignette content and questions were refined for internal consistency before use in a national implementation trial. RESULTS:Internal consistency was acceptable (Cronbach's α = 0.74). In the IMPRovE trial, participants completed three vignettes per time point (score range: 0-9). Inter-rater reliability was almost perfect (Cohen's κ = 0.92) from 873 responses across 97 GPs. CONCLUSIONS:This study offers a rigorous, context-sensitive method for evaluating guideline-concordant care where recommendations require clinical judgment. Successfully implemented in a national trial, this approach offers a replicable method for evaluating guideline implementation where recommendations require nuanced clinical judgment. IMPROVE TRIAL REGISTRATION:ACTRN12620001163998, November 2020. SPANISH ABSTRACT:http://links.lww.com/IJEBH/A597.

OBJECTIVES:Amid the unmet need for contraception and safe abortion care globally, harnessing the capabilities of primary care nurses and midwives is vital for facilitating equitable access to these critical healthcare services. We aimed to evaluate the impact of interventions delivered by primary care nurses and/or midwives on facilitating access to contraception and abortion care. STUDY DESIGN:We conducted a systematic review in accordance with PRISMA guidelines and searched five electronic databases in September 2023. A narrative synthesis was conducted with analysis informed by the Levesque et al framework for access to healthcare. RESULTS:Twenty-three articles met the inclusion criteria; 20 related to contraception and three to abortion care. Access to contraception and abortion care was predominantly focused on addressing consumer-related factors such as perception of healthcare needs and support to engage with services. Findings suggested home visiting, telehealth and reproductive counselling interventions by primary care nurses and midwives can be effective at increasing women's access to contraception. There was some evidence these clinicians could be acceptable providers of medical abortion; however, there were no articles on procedural abortion. CONCLUSIONS:Primary care nurses and midwives have the potential to improve women's access to contraception care, particularly through the use of home visiting or telehealth strategies. However, evidence on how nurses and midwives can support access to abortion care is scarce and more research is needed, particularly for procedural abortion. Further research should also target under-studied access factors, including the acceptability of nurses and midwives providing contraception and abortion care and consumers' ability to reach and pay for this healthcare.

In Australia, general practitioner (GP) consultations for work-related injuries are funded by workers’ compensation and GP care for non-work-related conditions is funded by public health insurance (Medicare Benefits Schedule, MBS). This study aimed to measure changes in the proportion and frequency of GP consultations after a long-term work injury, including both Medicare and workers’ compensation funded care, and to assess the proportion of GP services funded by each scheme. This retrospective cohort study linked administrative GP records from MBS and workers’ compensation systems in New South Wales, Australia. The study included injured workers with long-duration (2 + years) compensation claims and community comparators. Primary outcome measures included the proportion and frequency of GP services, measured in the year pre-injury, and each of the first two years post-injury. Mixed-effects negative binomial regression was used to compare outcomes between groups during all three study periods. The cohort included 3170 injured workers and 7636 community controls. The annual median GP services increased from 5 (Interquartile range 2–10) pre-injury to 19 (IQR 12–27) in the first-year post-injury and decreased to 16 (IQR 10–23) in the second year. Compared to the community control cohort, injured workers used 3.6 (95

Emergency contraception can be used to prevent pregnancy when contraception has failed or was not used, or after a sexual assault. Methods of emergency contraception available in Australia include 2 kinds of oral pills (levonorgestrel and ulipristal acetate) and the copper intrauterine device. Oral emergency contraception can be obtained from pharmacies without a prescription, while the copper intrauterine device must be inserted by a trained healthcare provider. For greatest effectiveness after unprotected sexual intercourse, oral levonorgestrel should be taken within 72 hours (3 days), ulipristal acetate should be taken within 120 hours (5 days) or the copper intrauterine device should be inserted within 120 hours.

As efforts to support pregnancy planning and improve preconception health are increasing at scale, appropriate systems to monitor progress are required. Despite developments in a few countries, no surveillance systems currently in operation are using a comprehensive set of indicators for monitoring preconception health. This Review describes relevant indicators, reflecting both system-level and individual-level factors, that can be drawn from routine data sources to form the basis for developing new surveillance systems. We present a new framework for national and international surveillance that incorporates, for the first time, community perspectives on the factors that matter most before pregnancy and parenthood. Finally, we describe an international collaboration working towards a core set of indicators that can be compared across low-income, middle-income, and high-income countries, and discuss future directions to enhance and expand international monitoring of pregnancy planning and preconception health.

BACKGROUND:Interconception care (ICC), provided between pregnancies, can improve women's health, pregnancy outcomes and infant health. Women face challenges in accessing and prioritising ICC due to issues including caring roles, transport and clinician availability. We aimed to elicit women's preferences for ICC engagement. METHODS:A discrete choice experiment (DCE) was conducted to assess women's preferences about ICC. Australian women who had experienced pregnancy completed an online survey in March 2024 comprised of questions about sociodemographic characteristics, ICC attitudes regarding informational needs, healthcare professional involvement and service location. We used a mixed logit model to analyse DCE responses, willingness to pay estimates for different attribute levels and applied latent class modelling to explore preference heterogeneity. Free text responses were grouped by key ideas. RESULTS:From 191 responses, numbers were similar across age categories, 46% had experienced pregnancy loss, and 87% had a child/children. Respondents preferred ICC provided by a nurse/midwife, offered during home visits or in-person consultations with a child-friendly waiting area, with appointments lasting 30 or 60 min, and at lower costs. There were no strong preferences regarding appointment wait times. Respondents favoured consultations scheduled up to 1 year after delivery. Follow-up questions indicated that most identified informational needs about emotional and mental health support (74.3%) as important, midwives were a preferred healthcare professional (71.7%) and general practice was the most favoured ICC location (64.9%). CONCLUSIONS:Ensuring clinician and setting familiarity, longer appointment times and lower appointment costs will support women's access to ICC. Policy and funding support are needed for ICC provision.