The ORIENT Study

Improving rural and regional access to long-acting reversible contraception and medical abortion through nurse-led models of care, task-sharing and telehealth 

 
Project Manager: Dr Jessica Botfield
Project team: Ms Mae Rilloraza
 
Australian women living in rural and regional areas experience many barriers to accessing long-acting reversible contraception (LARC) and early medical abortion (EMA) services.
 
ORIENT (ImprOving Rural and regIonal accEss to long-acting reversible contraceptioN and medical abortion through nurse-led models of care, Tasksharing and telehealth) is a stepped-wedge pragmatic cluster-randomised controlled trial which aims 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.
 
The nurse-led model of care was co-designed with consumers and women’s health professionals, ensuring that the intervention can meet consumer needs, is evidence-based, feasible, sustainable and offers the best chance of success. Practices were randomised to implement the model sequentially, with the comparator being usual care. All practices received implementation support including:
  • Free online accredited LARC and EMA training
  • An online educational outreach session to discuss practical strategies for implementing the nurse-led model, tailored to each practice
  • Enrolment into the AusCAPPS Network, an Australia-wide virtual community of practice that connects EMA and LARC providers through peer-networking opportunities and access to resources and training
  • Reimbursement and continuing professional development points

 We are in the final phases of the study and are currently undertaking the process evaluation and health economic evaluation (2025/26).

This project is supported by the Medical Research Future Fund.

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Recruitment for this study has closed

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Publications

ORIENT stepped wedge trial statistical analysis plan

Kasza J, Grantham K, Botfield J, Mazza D, Rilloraza M.

Monash University. 2025 May. https://doi.org/10.26180/28953290.v2

An Acceptability and Feasibility Study of a Nurse-Led Model of Contraception and Abortion Care in Rural General Practice

Moulton J, Botfield J, Arefadib N, Freilich K, Mazza D.

Journal of advanced nursing. 2025 Jan 22. doi: 10.1111/jan.16777. Online ahead of print.

A nurse-led model of care to improve access to contraception and abortion in rural general practice: Co-design with consumers and providers

Moulton J, Arefadib N, Botifeld J, Freilich K, Tomnay J, Bateson D, Black K, Nornman W, Mazza D. 

Journal of advanced nursing. 2025 Feb;81(2):1019-1037. doi: 10.1111/jan.16299. Epub 2024 Jul 2.

Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review

Moulton J, Botifled J, Subasinghe A, Withanage N, Mazza D. 

Journal of clinical nursing. 2024 Aug;33(8):2971-3017. doi: 10.1111/jocn.17106. Epub 2024 Mar 18.

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

Mazza D, Shankar M, Botfield J, Moulton J, Chakraborty S, Black K, Tomnay J, Bateson D, Church K, Laba T, Kasza J, Norman W.

BMJ Open. 2023 Feb;13(3):e065137.

Co-design of a nurse-led model of care to increase access to medical abortion and contraception in rural and regional general practice: A protocol

Moulton J, Mazza D, Tomnay J, Bateson D, Norman W, Black K, Subasinghe A. 

Aust J Rural Health. 2022 Dec; 30(6): 876-883.

Nurse-led service delivery models in primary care: a scoping review protocol

Moulton J, Withanage N, Subasinghe A, Mazza D. 

BMJP Open. 2022 Sept; 6(3): BJGPO.2021.0194.

Practice nurse provision of early medical abortion in general practice: opportunities and limitations

Moulton J, Subasinghe A, Mazza D. 

Aust J Prim Health. 2021 Dec;27(6): 427-430.