Original ResearchStrategies used to increase chlamydia screening in general practice: a qualitative study
Introduction
The Department of Health National Chlamydia Screening Programme (NCSP) is being implemented across England to control chlamydia through the early detection and treatment of asymptomatic infection, to prevent the development of sequelae and to reduce onward transmission.1, 2, 3 The NCSP offers chlamydia screening, in both healthcare and non-healthcare settings, to those at greatest risk of chlamydia, i.e. young men and women under 25 years who have ever been sexually active.4 The NCSP is being implemented in phases. Phase 1 started in 2003 in 10 programme areas, and Phase 2 started in 2004 in a further 16 areas. In 2004, all programme areas were encouraged to introduce general practice screening.3, 5, 6
Each programme area has a multidisciplinary local chlamydia screening steering group and a chlamydia screening co-ordinator, supported by nursing and administrative staff, who manage local implementation from a local screening office. The co-ordinator line manages the screening staff and is responsible for implementing, co-ordinating and developing the local screening programme in a variety of settings, including general practice. This includes negotiation with local stakeholder groups involved in screening, to ensure that the screening targets of the primary care trust (PCT) are met. The chlamydia screening office is also responsible for management of screening results and partner notification, data reporting and evaluation of the local programme.
Mathematical modelling has shown that if 50% of the at-risk population are screened and 20% of partners are treated, the prevalence of chlamydia can be reduced by 40% at 1 year and 89% at 10 years.7 To reach this target, general practices should offer chlamydia screening to most at-risk patients who attend their surgery, for whatever reason. However, the rate of chlamydia screening in general practices has been extremely variable.5 Several studies have indicated that general practices are cautious about introducing screening due to the perceived increase in workload, time pressures and costs.8, 9, 10
The aim of this study was to use qualitative methods to explore what strategies are used by screening co-ordinators and practice staff to overcome the barriers to chlamydia screening in general practice, and what further strategies are needed to increase chlamydia screening in practices.
Section snippets
Study population and ethics
In order to benefit from the experience of co-ordinators who had worked with many general practices involved in screening, co-ordinators in Phase 1 and 2 programme areas where there was significant chlamydia screening in several general practices were selected purposively. Disaggregate chlamydia testing activity data (individual records are reported quarterly, directly to the HPA Centre for Infections) were used for each of the 26 programme areas within England.5 Seven areas where there was no
Results
The nine co-ordinators facilitated screening in 244 general practices. One co-ordinator had primary care experience, although all nine co-cordinators had extensive experience of working in sexual health. The number of chlamydia screening tests submitted by each general practice and programme area varied considerably, from <0.2 to 26.4% of 16–24 year olds per year (Table 1), with 10% of screening tests positive. Fifty percent of practices in the programme areas studied had undertaken fewer than
Main findings
From April 2003 to March 2005, only 8% of the 224 general practices in the nine programme areas studied had undertaken more than 50 tests. The higher screening practices had a champion who drove the screening process forward, and were offering screening to all patients in the target age group whenever they attended. They had also facilitated the screening process by the use of computer prompts, test kits in the reception area, special youth clinics and involvement of receptionists (Table 2).
Acknowledgements
The authors wish to thank all the chlamydia screening co-ordinators who participated, so willingly, in this study; Lynsey Emmett, who provided screening data; Kevin Fenton and Scott LaMontagne, who provided advice on early study design; Jiyoon Knight and Allison Bates, for transcribing the interviews; Jill Whiting for all her assistance obtaining ethical committee and grant approval, organizing the interviews and taking notes; and Rebecca Howell-Jones for her comments on the manuscript.
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A Practice Improvement Intervention Increases Chlamydia Screening Among Young Women at a Women's Health Practice
2013, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal NursingCitation Excerpt :Other practices may set smaller, more specific goals in time increments over a longer period of time, which may be important for sustaining higher screening rates. Studies suggest the key role of an office champion/provider leader to effect change (e.g., McNulty et al., 2008). This was a key component in this study and suggests that nurse practitioners or nurses interested in changing provider practice should “seize” the opportunity where leaders exist to implement recommended chlamydia screening practices.
Health promotion and disease prevention in general practice and primary care: a scoping study
2017, Primary Health Care Research and DevelopmentPromoting chlamydia screening with posters and leaflets in general practice-a qualitative study
2016, Social Work and Community Practice