Alaina Vaisey

Chlamydia prevalence in young attenders of rural and regional primary care services in Australia: a cross-sectional survey.

Objective: To estimate chlamydia prevalence among 16–29‐year‐olds attending general practice clinics in Australia.

The chlamydia knowledge, awareness and testing practices of Australian general practitioners and practice nurses: survey findings from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt)

BackgroundACCEPt, a large cluster randomized control trial, aims to determine if annual testing for 16 to 29 year olds in general practice can reduce chlamydia prevalence. ACCEPt is the first trial investigating the potential role of practice nurses (PN) in chlamydia testing. To inform the design of the ACCEPt intervention, we aimed to determine the chlamydia knowledge, attitudes, and testing practices of participating general practitioners (GPs) and PNs.MethodsGPs and PNs from 143 clinics recruited from 52 areas in 4 Australian states were asked to complete a survey at time of recruitment. Responses of PNs and GPs were compared using conditional logistic regression to account for possible intra cluster correlation within clinics.ResultsOf the PNs and GPs enrolled in ACCEPt, 81% and 72% completed the questionnaire respectively. Less than a third of PNs (23%) and GPs (32%) correctly identified the two age groups with highest infection rates in women and only 16% vs 17% the correct age groups in men. More PNs than GPs would offer testing opportunistically to asymptomatic patients aged ≤25 years; women having a pap smear (84% vs 55%, P<0.01); antenatal checkup (83% vs 44%, P<0.01) and Aboriginal men with a sore throat (79% vs 33%, P<0.01), but also to patients outside of the guideline age group at the time of the survey; 26 year old males presenting for a medical check (78% vs 30%, P = <0.01) and 33 year old females presenting for a pill prescription (83% vs 55%, P<0.01). More PNs than GPs knew that retesting was recommended after chlamydia treatment (93% vs 87%, P=0.027); and the recommended timeframe was 3 months (66% vs 26%, P<0.01). A high proportion of PNs (90%) agreed that they could conduct chlamydia testing in general practice, with 79% wanting greater involvement and 89% further training.ConclusionsOur survey reveals gaps in chlamydia knowledge and management among GPs and PNs that may be contributing to low testing rates in general practice. The ACCEPt intervention is well targeted to address these and support clinicians in increasing testing rates. PNs could have a role in increasing chlamydia testing.

Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions.

BackgroundChlamydia notifications continue to rise in young people in many countries and regular chlamydia testing is an important prevention strategy. Although there have been initiatives to increase testing in primary care, none have specifically investigated the role of practice nurses (PNs) in maximising testing rates. PNs have previously expressed a willingness to be involved, but noted lack of support from general practitioners (GPs) as a barrier. We sought GPs’ attitudes and opinions on PNs taking an expanded role in chlamydia testing and partner notification.MethodsIn the context of a cluster randomised trial in mostly rural towns in 4 Australian states, semi structured interviews were conducted with 44 GPs between March 2011 and July 2012. Data relating to PN involvement in chlamydia testing were thematically analysed using a conventional content analysis approach.ResultsThe majority of GPs interviewed felt that a role for PNs in chlamydia testing was appropriate. GPs felt that PNs had more time for patient education and advice, that patients would find PNs easier to talk to and less intimidating than GPs, and that GPs themselves could benefit through a reduction in their workload. Although GPs felt that PNs could be utilised more effectively for preventative health activities such as chlamydia testing, many raised concerns about how these activities would be renumerated whilst some felt that existing workload pressures for PNs could make it difficult for them to expand their role. Whilst some rural GPs recognised that PNs might be well placed to conduct partner notification, they also recognised that issues of patient privacy and confidentiality related to living in a “small town” was also a concern.ConclusionThis is the first qualitative study to explore GPs’ views around an increased role for PNs in chlamydia testing. Despite the concerns raised by PNs, these findings suggest that GPs support the concept and recognise that PNs are suited to the role. However issues raised, such as funding and remuneration may act as barriers that will need to be addressed before PNs are supported to make a contribution to increasing chlamydia testing rates in general practice.

Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial

BACKGROUND Screening young adults who are sexually active for genital Chlamydia trachomatis infection is promoted in several high-income countries, but its effectiveness at the population level is highly debated. We aimed to investigate the effects of opportunistic chlamydia testing in primary care on the estimated chlamydia prevalence in the population aged 16-29 years in Australia. METHODS We did a cluster-randomised controlled trial. Clusters were rural towns with a minimum of 500 women and men aged 16-29 years and no more than six primary care clinics. We randomly allocated each cluster using a computer-generated minimisation algorithm to receive a multifaceted, clinic-based chlamydia testing intervention or to continue usual care. The intervention included computerised reminders to test patients, an education package, payments for chlamydia testing, and feedback on testing rates. The primary outcome was chlamydia prevalence, estimated before randomisation (survey 1) and at the end of the trial (survey 2) in patients aged 16-29 years who attended the clinics. Analyses were done by intention to treat. General practitioners and clinic staff were aware of group allocation, whereas patients and laboratory staff who performed the chlamydia tests were not. This trial was completed on Dec 31, 2015, and is registered (ACTRN12610000297022). FINDINGS Between Dec 14, 2010, and Sept 14, 2015, 26 clusters (63 clinics) received the chlamydia testing intervention and 26 (67 clinics) continued usual care. Over a mean duration of 3·1 years (SD 0·3), 93 828 young adults attended intervention clinics and 86 527 attended control clinics. The estimated chlamydia prevalence decreased from 5·0% (95% CI 3·8 to 6·2) at survey 1 to 3·4% (2·7 to 4·1) at survey 2 in the intervention clusters (difference -1·6%, 95% CI -2·9 to -0·3) and from 4·6% (95% CI 3·5 to 5·7) at survey 1 to 3·4% (2·4 to 4·5) at survey 2 in the control clusters (difference -1·1%, -2·7 to 0·5). The unadjusted odds ratio for the difference between intervention and control clusters was 0·9 (95% CI 0·5 to 1·5). INTERPRETATION These findings, in conjunction with evidence about the feasibility of sustained uptake of opportunistic testing in primary care, indicate that sizeable reductions in chlamydia prevalence might not be achievable. FUNDING Australian Government Department of Health, National Health and Medical Research Council, Victorian Department of Health and Human Services, and New South Wales Ministry of Health.

‘It Opened My Eyes’—examining the impact of a multifaceted chlamydia testing intervention on general practitioners using Normalization Process Theory

Background Chlamydia is the most common notifiable sexually transmissible infection in Australia. Left untreated, it can develop into pelvic inflammatory disease and infertility. The majority of notifications come from general practice and it is ideally situated to test young Australians. Objectives The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a multifaceted intervention that aimed to reduce chlamydia prevalence by increasing testing in 16- to 29-year-olds attending general practice. GPs were interviewed to describe the effectiveness of the ACCEPt intervention in integrating chlamydia testing into routine practice using Normalization Process Theory (NPT). Methods GPs were purposively selected based on age, gender, geographic location and size of practice at baseline and midpoint. Interview data were analysed regarding the intervention components and results were interpreted using NPT. Results A total of 44 GPs at baseline and 24 at midpoint were interviewed. Most GPs reported offering a test based on age at midpoint versus offering a test based on symptoms or patient request at baseline. Quarterly feedback was the most significant ACCEPt component for facilitating a chlamydia test. Conclusions The ACCEPt intervention has been able to moderately normalize chlamydia testing among GPs, although the components had varying levels of effectiveness. NPT can demonstrate the effective implementation of an intervention in general practice and has been valuable in understanding which components are essential and which components can be improved upon.

The impact of a chlamydia education program on practice nurse's knowledge and attitudes in relation to chlamydia testing: a cross-sectional survey.

UNLABELLED Background We aimed to determine the impact of a chlamydia (Chlamydia trachomatis) education program on the knowledge of and attitudes towards chlamydia testing of practice nurses (PNs). METHODS A cross-sectional survey was conducted at baseline and 6-12 months following recruitment with PNs in the Australian Chlamydia Control Effectiveness Pilot. Likert scales were analysed as continuous variables (scores), and t-tests were used to assess changes in mean scores between survey rounds and groups. RESULTS Of the 72 PNs who completed both surveys, 42 received education. Epidemiology knowledge scores increased significantly between surveys in the education group (P<0.01), with change in knowledge being greater in the education group compared with the non-education group (P<0.01). Knowledge of recommended testing scenarios (P=0.01) and retesting following treatment (P<0.01) increased in the education group. Attitudes to testing scores improved over time in the education group (P=0.03), with PNs more likely to want increased involvement in chlamydia testing (P<0.01). Change in overall attitude scores towards testing between surveys was higher in the education group (P=0.05). Barriers to chlamydia testing scores also increased in the education group (P=0.03), with change in barriers greater in the education vs the non-education group (P=0.03). CONCLUSION The education program led to improved knowledge and attitudes to chlamydia, and could be made available to PNs working in general practice. Future analyses will determine if the education program plus other initiatives can increase testing rates.

P5.011 Are Australian General Practitioners (GPs) and Practise Nurses (PNs) Equipped For Increased Chlamydia Testing? Findings from the Australian Chlamydia Control Effectiveness Pilot (ACCEPt)

Background ACCEPt, a large cluster randomised control trial, aims to determine if annual testing for 16 to 29 year olds in general practise can reduce chlamydia prevalence. ACCEPt is also the first trial investigating the potential role of the PN in chlamydia testing. To inform the intervention, GPs’ and PNs’ chlamydia knowledge and practises were explored. Methods GPs and PNs from 143 clinics were recruited from 54 postcodes in 4 Australian States and asked to complete a survey at time of recruitment. Survey responses were compared using conditional logistic regression to account for GPs and PNs from the same clinics participating. Results Of 607 GPs and 126 PNs enrolled in ACCEPt, 86% and 78% completed the questionnaire, respectively. A third of GPs (32%) compared to 23% of PNs (P = 0.076) correctly identified the two age groups with the highest infection rates in women and only 17% vs 16% (P = 0.942) identified the correct age groups in men. Fewer GPs than PNs would offer testing opportunistically to asymptomatic young patients, including women having a Pap smear (55% vs. 84%, P = < 0.001); antenatal checkup (44% vs. 83%, P = < 0.001) and Aboriginal men with a sore throat (33% vs. 79%, P = < 0.001). Fewer GPs than PNs knew that retesting was recommended after chlamydia treatment (87% vs. 93%, P = 0.027); and that the recommended timeframe for retesting was 3 months (26% vs 66%, P = < 0.001). Under half of PNs (41%) reported involvement in chlamydia testing, with 79% wanting greater involvement and 87% wanting further training. Conclusion Our survey reveals more gaps in chlamydia knowledge and management among GPs than PNs, which may be contributing to low testing rates in general practise. PNs have a role in increasing chlamydia testing.