Contraception advice incentive for GPs linked to 'profound' reduction in abortions

A scheme offering GPs financial incentives to provide women with information about long-acting reversible contraception (LARC) was associated with an increase in the use of these methods and a substantial fall in the number of abortions, new research shows.

A large-scale analysis suggests a financial incentive scheme for GPs can increase women's uptake of long-acting reversible contraception. | GETTY IMAGES
A large-scale analysis suggests a financial incentive scheme for GPs can increase women's uptake of long-acting reversible contraception. | GETTY IMAGES

The introduction of a QOF target for GPs to provide information about LARC to female patients saw the number of abortions fall by nearly 40%, according to a large scale analysis published in PLoS Medicine.

Researchers from Imperial College London assessed the impact of the QOF target, introduced in 2009/2010, by analysing data from the health records of over 3 million women in England, Wales and Scotland, using the Clinical Practice Research Datalink.

In the 4 years after the introduction of the scheme, the study found there was a 13% increase in LARC prescriptions (or an absolute increase of 4.5 prescriptions per 1,000 women) above what would have been expected.

During the same 4-year period there was a fall of nearly 17% in the number of prescriptions for non-LARC contraception (or an absolute decrease of 42 prescriptions per 1,000 women), suggesting a major switch in women's choice of contraceptive method.

The researchers also reported a 38% more than expected reduction in abortions (or an absolute reduction of 5.3 per 1,000 women) four years after the incentive was introduced. This is equivalent of 95,170 fewer abortions than expected, if the results were extrapolated across the whole UK population.

Most of the impact on LARC prescriptions and abortions was among women under 25 years old, and those from deprived areas.

Simple intervention

Dr Richard Ma, a GP and lead researcher on the study from Imperial College London, said: 'Our study suggests if women were better informed about more effective and reliable methods such as long-acting contraceptives, they might choose these over less reliable methods. This could reduce the number of unplanned and unwanted pregnancies. We expected this study would show the incentive had led to some change in behaviour but we never expected it to reveal such a profound effect, especially for a simple intervention and a relatively modest incentive.'

LARC methods include the contraceptive injection (effective for 3 months), contraceptive implant (effective for 3 years), levonorgestrel-releasing IUS (effective for 5 years), and copper IUD (effective for up to 10 years).

The QOF target required GPs to provide information on LARC to women between the ages of 13–54 who had previously received a prescription for contraceptives, including emergency hormonal contraception. The information could be given in person, as a text message or in a leaflet. 

GPs received a payment of around £700 per year for an average sized practice of 6,000 patients if they reached the target of providing information to 50% to 90% of women.

Regular review

The study authors emphasise their research shows only an association between the information provided to women, and the number of LARC prescriptions and abortions, and does not prove a causal link. Other awareness campaigns and improved access to contraceptive methods might have contributed to the findings.

Professor Sonia Saxena, GP and co-author of the study, also from Imperial College London, added: ‘There are two important points to make clear about this scheme. The first is 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’.

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