Salisbury Chris, Macleod John, Egger Matthias, McCarthy Anne, Patel Rita, Holloway Aisha, Ibrahim Fowzia, Sterne Jonathan A C, Horner Paddy, Low Nicola
Academic Unit of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL, UK.
Br J Gen Pract. 2006 Feb;56(523):99-103.
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.
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.
Population based cross-sectional study.
Twenty-seven general practices around Bristol and Birmingham.
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.
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.
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.
英格兰正在推行对生殖器衣原体感染的机会性筛查，但缺乏该方法有效性的证据。关于年轻人使用初级保健服务的数据不足，无法确定与基于人群的系统方法相比，机会性筛查的潜在覆盖率。
估计年轻男性和女性对初级保健服务的使用情况；比较机会性衣原体筛查与系统性邮寄方法的潜在覆盖率。
基于人群的横断面研究。
布里斯托尔和伯明翰周围的27家全科诊所。
向年龄在16 - 24岁的患者随机样本邮寄衣原体筛查包。我们从全科诊所记录中收集面对面咨询的详细信息。采用生存和人时方法估计1年内就诊于全科诊所的累积概率，以及机会性和系统性邮寄衣原体筛查所达到的覆盖率。
在12973名符合条件的患者中，估计16 - 24岁的男性中有60.4%（95%置信区间[CI]=58.3%至62.5%），女性中有75.3%（73.7%至76.9%）在1年期间至少就诊一次。在此期间，估计21.3%的患者不会就诊于全科诊所，但会通过邮寄筛查被联系到，9.2%的患者不会收到邮寄邀请但会就诊于全科诊所，11.8%的患者两种方法都会遗漏。
如果单独使用，衣原体筛查的机会性方法和基于人群的方法都无法联系到相当一部分目标人群。将两种策略结合的务实方法可能会实现更高的覆盖率。
