Evidence map›Paper›PMID 36948556›Full record

ArticleBMJ open2023

Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth (ORIENT): a protocol for a stepped-wedge pragmatic cluster-randomised controlled trial in Australian general practice.

Danielle Mazza, Mridula Shankar, Jessica R Botfield, Jessica E Moulton, Samantha Paubrey Chakraborty, Kirsten Black, Jane Tomnay, Deborah Bateson, Jody Church, Tracey-Lea Laba and 2 more

Open access · goldAbstract readClinical Trial Protocol
In one paragraph

Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
3.2field-weighted citation impact, top 9% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.

  1. Pooled it
  2. Demographic Factors Influencing Eligibility for EMA in South Australia.The Australian & New Zealand journal of obstetrics & gynaecology · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 5 institutions in 3 countries.

Danielle MazzaFaculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia Danielle.Mazza@monash.edu.ORCID 0000-0001-6158-7376
Mridula ShankarFaculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia.ORCID 0000-0002-4652-6396
Jessica R BotfieldFaculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia.ORCID 0000-0001-6157-9739
Jessica E MoultonFaculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia.ORCID 0000-0001-7172-9470
Samantha Paubrey ChakrabortyFaculty of Medicine Nursing and Health Sciences, Department of General Practice, Monash University, Clayton, Victoria, Australia.ORCID 0000-0002-9708-4532
Kirsten BlackFaculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Jane TomnayDepartment of Rural Health, University of Melbourne, Melbourne, Victoria, Australia.
Deborah BatesonObstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia.ORCID 0000-0003-1035-7110
Jody ChurchCentre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia.
Tracey-Lea LabaCentre for Health Economics Research and Evaluation, University of Technology Sydney Faculty of Health, Ultimo, New South Wales, Australia.
Jessica KaszaSchool of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.ORCID 0000-0002-8940-0136
Wendy V NormanDepartment of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada.ORCID 0000-0003-4340-7882
Australian Regenerative Medicine Institute · AUThe University of Sydney · AUUniversity of Technology Sydney · AUThe University of Melbourne · AUUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionWomen living in rural and regional Australia often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Nurse-led models of care can improve access to these services but have not been evaluated in Australian general practice. The primary aim of the ORIENT trial (ImprOving Rural and regIonal accEss to long acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is to assess the effectiveness of a nurse-led model of care in general practice at increasing uptake of LARC and improving access to medical abortion in rural and regional areas. METHODS AND ANALYSIS: ORIENT is a stepped-wedge pragmatic cluster-randomised controlled trial. We will enrol 32 general practices (clusters) in rural or regional Australia, that have at least two general practitioners, one practice nurse and one practice manager. The nurse-led model of care (the intervention) will be codesigned with key women's health stakeholders. Clusters will be randomised to implement the model sequentially, with the comparator being usual care. Clusters will receive implementation support through clinical upskilling, educational outreach and engagement in an online community of practice. The primary outcome is the change in the rate of LARC prescribing comparing control and intervention phases; secondary outcomes include change in the rate of medical abortion prescribing and provision of related telehealth services. A within-trial economic analysis will determine the relative costs and benefits of the model on the prescribing rates of LARC and medical abortion compared with usual care. A realist evaluation will provide contextual information regarding model implementation informing considerations for scale-up. Supporting nurses to work to their full scope of practice has the potential to increase LARC and medical abortion access in rural and regional Australia. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Monash University Human Research Ethics Committee (Project ID: 29476). Findings will be disseminated via multiple avenues including a knowledge exchange workshop, policy briefs, conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12622000086763).

Indexed as

Abortion, InducedGeneral PracticeLong-Acting Reversible ContraceptionTelemedicineAustraliaFemaleHumansNurse's RolePragmatic Clinical Trials as TopicPregnancyRandomized Controlled Trials as Topicprimary carepublic healthquality in health care

Identifiers

PMID36948556
PMCPMC10040016
OpenAlexW4353098585

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.