Increasing the uptake of opportunistic chlamydia screening: a pilot study in general practice.
BACKGROUND
Genitourinary Chlamydia trachomatis infection is common and associated with considerable personal and public health cost. Effective detection strategies are needed.


OBJECTIVE
To assess feasibility of an opportunistic incentivised chlamydia screening programme in general practice over six months.


METHODS
This study was designed as a pilot for a randomised controlled trial in primary care. Three general practices were randomly allocated to intervention (two practices) and control groups. The intervention involved practice education, self-sample collection and practice incentives (funding and feedback) for a three-month 'active' intervention period. Feedback and education was discontinued during the second three-month period. Practice-specific nurse- or doctor-led strategies were developed for identifying, testing, treating and recalling male and female patients aged 16-24 years. The main outcome measure was the difference between the practices' chlamydia screening rates over the six months following introduction of the intervention, controlling for baseline rates from the previous year.


RESULTS
Chlamydia testing rates during the year prior to the intervention ranged from 2.9% to 7.0% of practice attendances by 16-24-year-olds. The intervention practices had higher rates of screening compared with the control practice (p<0.001) at three months, but both practices reverted to pre-intervention rates by six months. The nurse-led screening strategy was more effective (35% declining to 5.5% over six months) than the doctor-led strategy (15% declining to 1.6% over six months) (p=0.04).


CONCLUSIONS
Incentivised opportunistic chlamydia screening of 16-24-year-old patients attending their general practitioner with a programme involving practice education, feedback and self-sample collection can increase screening rates.
Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, PO Box 7343 Wellington, New Zealand. bev.lawton@otago.ac.nz
Beverley A
BA
Lawton
Sally B
SB
Rose
C Raina
CR
Elley
Collette
C
Bromhead
E Jane
EJ
MacDonald
Michael G
MG
Baker
D000293:Adolescent; D002690:Chlamydia Infections / Q000175:diagnosis*; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D058007:Physicians, Primary Care; D010865:Pilot Projects; D059017:Primary Care Nursing; D011320:Primary Health Care / Q000379:methods*; D055815:Young Adult