RELEASE (REdressing Long-tErm Antidepressant uSE): protocol for a 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1 in general practice.

BACKGROUND: Many people experience withdrawal symptoms when they attempt to stop antidepressants. Withdrawal symptoms are readily misconstrued for relapse or ongoing need for medication, contributing to long-term use (> 12 months). Long-term antidepressant use is increasing internationally yet is not recommended for most people. Long-term use is associated with adverse effects including weight gain, sexual dysfunction, lethargy, emotional numbing and increased risk of falls and fractures. This study aims to determine the effectiveness of two multi-strategy interventions (RELEASE and RELEASE+) in supporting the safe cessation of long-term antidepressants, estimate cost-effectiveness, and evaluate implementation strategies. METHODS: DESIGN: 3-arm pragmatic cluster randomised controlled trial effectiveness-implementation hybrid type-1. SETTING: primary care general practices in southeast Queensland, Australia. POPULATION: adults 18 years or older taking antidepressants for longer than 1 year. Practices will be randomised on a 1.5:1:1 ratio of Usual care:RELEASE:RELEASE+. INTERVENTION: RELEASE for patients includes evidence-based information and resources and an invitation to medication review; RELEASE for GPs includes education, training and printable resources via practice management software. RELEASE+ includes additional internet support for patients and prescribing support including audit and feedback for GPs. OUTCOME MEASURES: the primary outcome is antidepressant use at 12 months self-reported by patients. Cessation is defined as 0 mg antidepressant maintained for at least 2 weeks. SECONDARY OUTCOMES: at 6 and 12 months are health-related quality of life, antidepressant side effects, well-being, withdrawal symptoms, emotional numbing, beliefs about antidepressants, depressive symptoms, and anxiety symptoms; and at 12 months 75% reduction in antidepressant dose; aggregated practice level antidepressant prescribing, and health service utilisation for costs. SAMPLE SIZE: 653 patients from 28 practices. A concurrent evaluation of implementation will be through mixed methods including interviews with up to 40 patients and primary care general practitioners, brief e-surveys, and study administrative data to assess implementation outcomes (adoption and fidelity). DISCUSSION: The RELEASE study will develop new knowledge applicable internationally on the effectiveness, cost-effectiveness, and implementation of two multi-strategy interventions in supporting the safe cessation of long-term antidepressants to improve primary health care and outcomes for patients. TRIAL REGISTRATION: ANZCTR, ACTRN12622001379707p. Registered on 27 October 2022.

Termination of pregnancy in Queensland post-decriminalisation: a content analysis of client records from an all-options pregnancy counselling organisation.

BACKGROUND: Termination of pregnancy (ToP) was decriminalised in Queensland, Australia, in December 2018. Although approximately 14 000 terminations are performed in Queensland annually, decriminalisation had addressed a known barrier to ToP access by supporting the legal right to access and enabling safe and regulated public pathways to ToP care. The post-decriminalised ToP experience in Queensland is unknown. Therefore, this study explored the reported reasons clients access information and support from an all-options pregnancy counselling service in Queensland with the aim of identifying the facilitators and barriers accessing ToP that remain post-decriminalisation in Queensland. METHODS: A two-part qualitative conventional and directed content analysis approach guided by the Socioecological Model was used to examine counsellor notes on interactions with clients (n =1933) between December 2018 and June 2020 at an all-options pregnancy counselling service in Queensland. FINDINGS: Key reasons for contacting the service were for financial assistance, ToP information, and support for decision making. Facilitators and barriers affecting ToP access interconnected across the Socioecological Model levels highlighting affordability, violence, stigma, knowledge, and information as key factors influencing ToP access post-decriminalisation in Queensland. CONCLUSIONS: Inclusive multisectoral action to support reproductive autonomy is needed in Queensland. Following decriminalisation, cost, stigma, and intimate partner violence continue to impede access to safe, compassionate, and timely abortion care. Future models of care must eliminate these barriers by developing public models of service provision, investing in workforce development, fully utilising the capacity of that workforce, and creating stronger connections between sexual and reproductive health and intimate partner violence services.