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Addressing long acting reversible contraception

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The ICGP is currently developing a new advanced certificate in long acting reversible contraception (LARC). Dr Geraldine Holland, coordinator of the ICGP LARC Programme, spoke to IMN about what the certificate will mean for GPs.
“Over the years we have had lots of requests from GPs and family planning doctors about standardising training in this area,” Dr Holland explained. “Although we have had the family planning certificate, we’ve never had standards, whereas in the UK it’s all very tight and controlled.”

In 2010, the ICGP carried out a pilot project that looked at planning and training in the area of long-acting contraception devices. The project looked at developing protocols in LARC training as well as the minimum number of insertions needed for continuing professional development accreditation.

“We published a report on that and now we’re moving on to try and launch it and get it out into the public arena,” Dr Holland told IMN. This is being carried out in phases.

“There are a lot of GPs out there who are very experienced in LARC, whether they’ve been trained by a pharmaceutical company, or whether they’ve received training abroad, or maybe someone has come to their practice to show them.

“So many of them have been working with these devices for years but they have never had a piece of paper to recognise this, or else they’ve done their certification years ago but never got reaccredited.”

Phase one began in October 2011 and offers an Advanced Certificate for GPs who are already providing the service. “They can apply online to the ICGP for the advanced certificate. They need to send us in a log of their experience.”

Doctors must have carried out a minimum number of insertions to apply.

“It is 12 in a year for intrauterine device (IUD) or intrauterine system (IUS) and five insertions in a year for Implanon devices.” Dr Holland said doctors must also carry out a clinical update.

“There are various options for that. They can attend one of our workshops. We’re just about to launch an e-learning module in LARC in April so that will allow doctors read up on latest clinical updates and guidelines.”

Doctors send in information on their practice, which is then vetted by the Reproductive and Sexual Health Committee in the ICGP. Five per cent of applications will have a practice visit, Dr Holland added.

GPs will also be asked to audit part of their LARC practice and once all this information is compiled, they receive the certificate. Dr Holland said that the programme is looking at increasing the number of tutors in Ireland who will be able to sign physicians off on this procedure.

“In particular for GP trainees, who may get experience in their practice. We’re looking for a lot of the trainers to become tutors. We’re working on workshops to update them; we’ve had one of those already and we’re having another one in May.”

The ICGP hopes that GP trainees will get access to LARC training at some point over their four years of training. Regarding the onset of new techniques in the area, Dr Holland said the focus is more on reinstatement of old techniques.

“We’re trying to promote the use of copper devices and we’re trying to spread the word that these devices are very reliable and very safe.” According to Dr Holland, copper devices have fallen out of favour over the years.

“Years ago most people went to family planning clinics for their contraception. There were well-trained family planning doctors doing all these techniques, then contraception largely moved into general practice so that skill mix was lost. With the advent of Mirena, people forgot about the copper coil.”

Dr Holland said there is a perception in Ireland that copper devices are not available and not licensed.

“We’re trying to address that. This is not a new technique but we’re trying to spread the word that these devices are much longer lasting, they last a minimum of 10 to 12 years, so there are less procedures overall.”

She acknowledged, however, that copper devices are not for all patients but noted that there are lots of options with different sizes available.

“There is actually more choice available for patients,” Dr Holland said. Overall, Dr Holland said, LARC devices are highly advocated.

“They are the best form of contraception because patients don’t have to think about them. They are the best methods for patients if they are agreeable and acceptable to the patients. They are reliable, suitable for all age groups, and also very useful in other contexts where oestrogen contraindicates diabetes.”

The ICGP website www.icgp.ie also contains useful information for patients regarding inserting devices, and guidelines around lost threads, or irregular bleeding.

 

 

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