Paying GP clinics to provide contraceptive advice is linked to fewer abortions, study finds
BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3617 (Published 16 September 2020) Cite this as: BMJ 2020;370:m3617
A scheme that paid general practices to offer information on long acting contraceptives (LARCs), such as the hormonal implant, was associated with an increase in their use and a fall in abortions, a study has found.
The paper published in PLOS Medicine1 estimated that, by 2013-14, the scheme had resulted in an additional 4.53 LARC prescriptions per 1000 women (relative increase 13.4%) above what was expected without the scheme.
Meanwhile, abortions fell 38% beyond what was expected (absolute reduction 5.3 per 1000 women) four years after the incentive was introduced. This is the equivalent of 95 170 fewer abortions than expected if extrapolated across the whole UK population.
The study authors said that they had not expected the scheme to have “such a profound effect, especially for a simple intervention and a relatively modest incentive.” However, they also emphasised that their research did not prove a direct link but showed only an association between the information given to women and the prescriptions or abortions.
Incentive scheme
In 2009 the UK government introduced the incentive for GPs to provide information about LARCs to any female patient aged 13-54 who had previously received a prescription for contraceptives, as part of the Quality and Outcomes Framework scheme. The advice had to be given in person, as a text message, or through a leaflet. For an average sized practice of 6000 patients, the target was worth about £700 a year.
Researchers from Imperial College London examined the records of more than three million female patients aged 13-54 who were registered with a primary care clinic in England, Wales, or Scotland, looking at their uptake of LARC and non-LARC hormonal contraception, as well as abortion rates from 2004-05 to 2013-14.
They found a small increase in trend (0.56 (95% confidence interval 0.54 to 0.59); P<0.001) in the LARC uptake rate in all ages before the scheme was introduced; however, when the incentive began they found a large and immediate increase (5.36 (5.26 to 5.45); P<0.001). This was followed by a “small but sustained decrease” in trend over the four years after the scheme (–0.35 (–0.42 to –0.28); P<0.001).
Overall, from 2004-05 to 2013-14, crude LARC uptake rates increased by 32.0% from 29.6 per 1000 women to 39.0 per 1000 women, compared with an 18.0% decrease in non-LARC hormonal contraception uptake.
Women aged 20-24 showed the largest step change and sustained trend increase in LARC uptake, the study found, and the largest falls in abortions were seen in female patients aged 13-19, those aged 20-24, and those from the most deprived group.
Sonia Saxena, GP and study author, said, “There are two important points to make clear about this scheme. The first is that the aim of the incentive was not to nudge women to choose LARC methods, but to consider the best options available to match their needs.
“The second point is that, as women’s circumstances change, regular review of contraceptive needs from primary care professionals, such as their GP or practice nurse, may help women to make better decisions about contraceptive methods that are appropriate for their life stage.”
The study was funded by the National Institute for Health Research.