Women's experiences of accessing a medical termination of pregnancy through a Queensland regional sexual health service: a qualitative study.

Background An estimated 25% of Australian women will undergo induced abortion. Few studies have explored Australian women's experiences of accessing medical termination of pregnancy (MToP). This study explored the experiences of women accessing MToP through a regional sexual health service in North Queensland. It aimed to determine the aspects of the process from seeking information about abortion to completion that worked well and to identify areas for improvement. METHODS: Semi-structured telephone interviews with 11 women who accessed MTOP at Cairns Sexual Health Service (CSHS) were conducted. Interviews were recorded and transcribed verbatim. A deductive analysis approach was used to analyse the data. RESULTS: Most women had little prior knowledge of MToP or access options and used the Internet to source information. Accessing MToP through a sexual health service was considered positive, non-judgemental, discrete and low-cost despite challenges of fitting in with appointment times and obtaining off-site ultrasound. GPs did not always provide referral; some women described experiences of stigma, discrimination and judgemental care during consultation and when obtaining ultrasounds. Concern for women living in more rural/remote areas was raised. Potential solutions including increased provision through rural general practitioners (GPs) and telehealth. CONCLUSION: Our study highlights the need for greater awareness of abortion options and access points among the community and healthcare providers. Access through sexual health clinics in regional settings is accepted; however, other options such as increased provision through rural GPs, primary health clinics, telehealth and nurse-led models of care could help overcome some of the barriers faced by rural and remote women.

Use of fetal fibronectin testing in women transferred for threatened preterm labour in remote far north Queensland.

BACKGROUND: Threatened preterm labour is a common reason for medical transfer from remote communities; however, many transferred women do not deliver preterm. A tool for prediction of preterm birth such as fetal fibronectin may reduce transfers and related social and economic costs. AIM: To review the use of fetal fibronectin testing in women transferred for threatened preterm labour from Cape York to Cairns Hospital between 2011 and 2015 and determine the role testing could play in reducing transfers and associated costs. MATERIALS/METHODS: Records from the Royal Flying Doctor Service and Cairns Hospital were accessed. Women transferred solely for threatened preterm labour were included in the study. Fetal fibronectin testing, hospital admission, outpatient stays and birth outcome data were collated and analysed. Costs were assigned using the National Hospital Cost Data Collection, round 19. RESULTS: Forty-seven women were included in the study; however, only 20 underwent fetal fibronectin testing. Transfer of 30 women who had either a negative test or were not tested but delivered at term resulted in 41 inpatient nights and 443 excess outpatient nights, costing an estimated AU$57 408. Aeromedical transfers were estimated to cost a further $151 500. CONCLUSION: Adherence to clinical guidelines and greater availability and use of fetal fibronectin testing in Cape York have the potential to reduce aeromedical transfers for threatened preterm labour. Substantial inpatient and excess outpatient stays could be avoided with associated reduction in health system and social costs. Strategies to improve adherence to guidelines and increase access to testing are required.

Ten years on: a review of medical terminations of pregnancy performed in a sexual health clinic.

Background Access to medical termination of pregnancy (MToP) services in regional Queensland remains inadequate and it is still possible for women and providers to be criminally prosecuted for accessing or providing abortion. Cairns Sexual Health Service (CSHS) has been providing medical terminations of pregnancy for 10 years, demonstrating that this service can be safely and successfully integrated into a primary healthcare setting. METHODS: A retrospective audit of MToPs performed between 2011 and 2015 was conducted to follow on from our previously reported audit covering 2006-09. RESULTS: In total, 1859 MToPs have been performed by CHSH since 2006, with 1712 within the 5-year period of 2011-15. Changes in clinical practice over this time have streamlined the service and reduced unsuccessful outcomes from 12.2% between 2006 and 2009 to 0.9% between 2011 and 2015. CONCLUSION: The initial provision of MToP through CSHS was anticipated to be a short-term arrangement; however, 10 years on, this service continues with strong community demand. Provision of MToP services through primary healthcare settings can help improve access for women living outside of major metropolitan areas. If moves to decriminalise abortion in Queensland are successful, there is potential for even greater access.

Enhanced surveillance for gonorrhoea in two diverse settings in Queensland in the 2000s: comparative epidemiology and selected management outcomes.

Gonorrhoea is an important sexually transmitted notifiable condition. This paper describes findings from two gonorrhoea enhanced surveillance programs operating during the 2000s in Queensland: one in the remote Torres and Northern Peninsula Area (T&NPA); the other in an urban region. The overall response rate in the T&NPA (2006-2011) was 82% (723 of 879), and in Brisbane Southside and West Moreton (BSWM) (2003-2011), it was 62% (1,494 of 2,401 notifications). In the T&NPA, cases were young (80% <25 years), Indigenous (97%) and 44% were male. In the BSWM, cases were predominantly male (76%), non-Indigenous (92%) and 42% were aged less than 25 years. Co-infection with chlamydia was found in 54% of males and 60% of females in the Torres, and in 18% of males and 35% of females in the BSWM. In the BSWM 35% of the men without a syphilis test recorded had reported sexual contact with men; similarly 34% of the men without an HIV test recorded had reported sexual contact with men. Compliance with recommended treatment (ceftriaxone) was greater than 90% in all years except 2008 (84%) in the T&NPA. Treatment compliance increased significantly, from 40% in 2003 to 84.4% in 2011 (P<0.0001) in the BSWM cohort. The proportion of contacts with a documented treatment date increased significantly in the T&NPA from 56% in 2009 to 76% in 2011 (P=0.019), after a system for follow-up with the clinician became routine. Gonorrhoea epidemiology and management challenges vary across Queensland populations. Enhanced surveillance allows public health authorities to monitor epidemiology and reminds clinicians to prioritise effective sexually transmitted infection treatment for their clients.

Emergency contraception over-the-counter: practices and attitudes of pharmacists and pharmacy assistants in far North Queensland.

BACKGROUND: Emergency contraception (EC) has been available as a Schedule 3 (over-the-counter, OTC) medication through Australian pharmacies since 2004. This study aimed to describe OTC EC dispensing services in pharmacies in the Cairns and Hinterland Health Service District and to explore the knowledge and attitudes of pharmacy staff. The study findings will assist in developing resources to support pharmacy staff in their OTC EC provision role. STUDY DESIGN: We conducted semi-structured interviews with pharmacy managers and pharmacists to determine the availability, cost, dispensing processes and distribution estimates of EC and anonymous surveys of pharmacy staff to examine their knowledge and attitudes. RESULTS: Forty-six (88%) of the 52 local pharmacies participated; 43 (93%) provide OTC EC at an average cost of $28.95. One hundred and forty-five staff surveys were completed. Few pharmacists identified Family Planning Queensland (FPQ) or the Cairns Sexual Health Service (CSHS) as referral options for women not meeting the dispensing criteria. A range of written information is provided to EC customers by 23 (53%) of pharmacies. CONCLUSIONS: This study has documented OTC EC dispensing services in the District and identified areas for improvement. A working group has been established to oversee the development and distribution of customer information packs and information for pharmacists on referral options.