title: Opportunistic and systematic screening for chlamydia: a study of consultations by young adults in general practice.
abstract: BACKGROUND
  Opportunistic screening for genital chlamydia infection is being introduced in England, but evidence for the effectiveness of this approach is lacking. There are insufficient data about young peoples' use of primary care services to determine the potential coverage of opportunistic screening in comparison with a systematic population-based approach.
  
  
  OBJECTIVE
  To estimate use of primary care services by young men and women; to compare potential coverage of opportunistic chlamydia screening with a systematic postal approach.
  
  
  METHODS
  Population based cross-sectional study.
  
  
  METHODS
  Twenty-seven general practices around Bristol and Birmingham.
  
  
  METHODS
  A random sample of patients aged 16-24 years were posted a chlamydia screening pack. We collected details of face-to-face consultations from general practice records. Survival and person-time methods were used to estimate the cumulative probability of attending general practice in 1 year and the coverage achieved by opportunistic and systematic postal chlamydia screening.
  
  
  RESULTS
  Of 12 973 eligible patients, an estimated 60.4% (95% confidence interval [CI] = 58.3 to 62.5%) of men and 75.3% (73.7 to 76.9%) of women aged 16-24 years attended their practice at least once in a 1-year period. During this period, an estimated 21.3% of patients would not attend their general practice but would be reached by postal screening, 9.2% would not receive a postal invitation but would attend their practice, and 11.8% would be missed by both methods.
  
  
  CONCLUSIONS
  Opportunistic and population-based approaches to chlamydia screening would both fail to contact a substantial minority of the target group, if used alone. A pragmatic approach combining both strategies might achieve higher coverage.
authors.affiliation: Academic Unit of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK. c.salisbury@bristol.ac.uk
authors.forename: Chris
authors.initials: C
authors.lastname: Salisbury
authors.forename: John
authors.initials: J
authors.lastname: Macleod
authors.forename: Matthias
authors.initials: M
authors.lastname: Egger
authors.forename: Anne
authors.initials: A
authors.lastname: McCarthy
authors.forename: Rita
authors.initials: R
authors.lastname: Patel
authors.forename: Aisha
authors.initials: A
authors.lastname: Holloway
authors.forename: Fowzia
authors.initials: F
authors.lastname: Ibrahim
authors.forename: Jonathan A C
authors.initials: JA
authors.lastname: Sterne
authors.forename: Paddy
authors.initials: P
authors.lastname: Horner
authors.forename: Nicola
authors.initials: N
authors.lastname: Low
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011177:Postal Service