Guide for doctors to refer patients to family planning services

Your guide to referring to family planning services

Eleonore Bridier For doctors

Today we officially launch our partnership with Healthshare, which allows you to refer your patients to our family planning services from within your practice management system.

We have seen over 600,000 abortion, vasectomy and contraception patients in 20 years of care. In that time, we made medical abortion available in Australia, and have been working with GPs like you, and other practitioners, to increase access to high quality abortion care nationally.

Whether you refer your patients on, or prefer to provide medical abortion, vasectomy or contraception services through your own practice, it can help to know what the concerns of patients are when accessing this type of care.

We take regular feedback from all our patients, and have a national repository of data about what works and what could be improved when it comes to accessing these services.

To try to address some of these issues, we have developed the following guide for family planning patient referrals.

Termination of pregnancy

Legalities: it is important to know what your legal obligations are concerning abortion, particularly about gestation limits and conscientious objection. Children By Choice provide an exceptional resource on their website.

Funding: for patients who have reached the legal gestation limit in their home state or territory, they may need to travel for a more complex procedure, which can incur significant costs. To help, Marie Stopes Australia has established a philanthropic fund and an interest-free loan scheme that may be able to assist with the additional financial burden.

Methods: there are several methods available to patients wishing to terminate a pregnancy, depending on gestation. We provide free pre-care appointments over the phone with a nurse if they are unsure of their decision. However, it can save time and frustration if your patients have the opportunity to discuss their options with you beforehand, especially if they would like to access a tele-abortion as the window of eligibility for an appointment is quite narrow (from 5 up to 8 weeks). To assist we have developed comparative information on our website, a factsheet available on Healthshare, and an online gestation calculator, which may useful.

Confirming a pregnancy: it can be a cause of anxiety for patients when they find out that they cannot be seen until they are at least 5 weeks pregnant. We recommend patients delay presentation to ensure we can confirm an intrauterine pregnancy. Otherwise, they may be charged a consult fee and not be able to proceed on the day.

Cost: even with a medical abortion over the phone, there can be unanticipated costs associated with confirming a pregnancy (i.e. blood test or ultrasound), medication (especially if your patient does not have a Medicare card) or follow up appointments to confirm successful termination. When looking at pricing options, patients are not always aware of the additional support services and visits that they may require, such as access to 24-hour nurses on call, decision-based counselling, interpreter services and the option of further treatment in the instance of a failed abortion.

Delaying referral: it’s crucial to remember that the longer a patient waits for access to an abortion, the further her gestation increases. This increases not only the cost of the procedure, but also the associated risks. For patients who would prefer or be more suited to a medical termination, there is a very small window (5 to 9 weeks for an in-clinic visit). Time is of the essence when referring or prescribing for patients seeking a termination.

Safety: While there are many factors to consider when accessing abortion services, the biggest priority is quality of care. What can be a confronting experience is made that much more comfortable with an experienced and knowledgeable practitioner. With additional support services (i.e. counsellors) on hand at no extra cost and strict clinical risk management practices in place, our day surgeries are independently accredited by the Australian Council on Healthcare Standards (ACHS) and recently received 7 Met with Merits regarding our quality of care.

Contraception at time of termination: it is not true that women cannot get a LARC at the time of their surgical pregnancy termination, and that they need to wait a certain amount of time before they can have an IUD or implant inserted. Women who have LARC at the time of their termination are less likely to experience repeat unplanned pregnancy and avoid being faced with considering another abortion procedure. Most women who have a surgical abortion choose to have IV sedation. With medical abortion, we provide insertions at a consultation 2 weeks after the medication has been taken, where we confirm the termination has been successful.

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Vasectomy

Hidden costs: patients often complain of having been referred to a urologist at significant out of pocket expense. If a patient has private hospital insurance, many urologists are charging an additional “gap fee” that isn’t covered by their insurance. This is in addition to their insurance provider’s excess. The total amount can be upwards of $3,000. Our vasectomy service is “gap free” for our privately insured patients visiting one of our many PHI approved clinics. The only additional cost, apart from their excess, may be a small fee for out of hours or weekend appointments.

Experience over credentials: some patients may feel a urologist is safer because they are specialists but it is important to note that they may only perform a vasectomy half a dozen times a year. In comparison, a vasectomy doctor resident at a family planning clinic will perform a great deal more, sometimes hundreds a year.

Recovery planning: if they work in a physically demanding role, vasectomy patients will need to take a significant amount of leave, or organise with their employer to do less physical work while they recover. It can take up to 4 weeks before they are able to return to a physically demanding job or strenuous exercise. They can book with us up to three months in advance, which helps ensure they get a booking when they are able to take leave.

Overcoming anxiety: the biggest barrier that most men face around vasectomy is fear. Combating anxieties with information can be a great help for a nervous patient. We provide answers to most of the questions and concerns most men are likely to have on our vasectomy website. We are also rolling out phone based pre-care appointments across our network, to ensure that patients feel prepared and know what to expect before they attend.

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Contraception

There are a number of hurdles when referring patients for long-acting reversible contraception (LARC). Patients might have a fear of the higher out of pocket cost, how painful the procedure may be, the inconvenience of insertion and/or removal, or anxiety associated with unfamiliar contraception methods. Half of our patients presenting for unplanned pregnancy termination were using the oral contraceptive pill and/or condoms. This is just one of the reasons we are serious about contraception counselling and LARC

Myths and barriers: there is a lot of misinformation and outdated practices. One of the most common barriers that patients experience is doctors who aren’t willing to provide IUDs to women who haven’t had children. While this was the prevailing attitude many years ago, these days there’s no reason to deny access to child-free patients. Most women get their information about contraception from friends, family members and their GP, so it’s crucial that at least one of these parties has the most up to date information or can refer them to someone who does.

Contraceptive counselling: overcoming fear with facts

If one of your patients is unsure about which option might be right for her, feel free to refer her to My Best Fit. My Best Fit is a peer-reviewed, globally utilised online contraception counselling tool developed by Marie Stopes International specifically for use by doctors and their patients to review her contraception choices. There are two modes: browsing and survey, with the latter walking patients through their contraceptive options based on their own needs and lifestyle to provide them with a contraceptive recommendation.

Convenience: assuming there is no risk of pregnancy, we are able to perform a new insertion, replacement or removal in one visit. We provide weekend appointments, as well as a 24-hour nurse-led aftercare helpline if patients have any follow up questions or concerns.

In some cities, we also offer walk-in services. Ask your patients to check our website location pages for more information on whether their local Marie Stopes clinic provides walk-in services including low cost LARC and free sexual health checks on specific days.

Managing pain: the advantage of getting a LARC inserted at a day surgery is that we can provide the choice between local anaesthetic and sedation. Women who might be anxious about the procedure are able to choose from these options based on their own preference. They can also see doctors who spend a lot of time working with LARCs, and this expertise with insertion and removal means less discomfort for the patient.

Contraceptive counselling and post-natal contraception: women who have recently given birth are a group at high risk of experiencing an unplanned pregnancy. However, when it comes to contraceptive counselling, there’s a significant gap in the information that patients can access around post-natal contraception. Many will be counselled to use options such as the mini pill while they breastfeed, which has lower typical use efficacy due to regime requirements than they may be used to (i.e. the combined pill). Moreover, some women who give birth do so in private and/or religious hospitals, which means they may not be given an opportunity to properly discuss contraception, or be given the option to take up LARC after birth.

Marie Stopes Australia is a proud Healthshare partner.

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