Lawton Beverley A, Rose Sally B, Elley C Raina, Bromhead Collette, MacDonald E Jane, Baker Michael G
Women's Health Research Centre, Department of Primary Health Care and General Practice, University of Otago, PO Box 7343 Wellington, New Zealand.
J Prim Health Care. 2010 Sep 1;2(3):199-207.
Genitourinary Chlamydia trachomatis infection is common and associated with considerable personal and public health cost. Effective detection strategies are needed.
To assess feasibility of an opportunistic incentivised chlamydia screening programme in general practice over six months.
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.
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).
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.
泌尿生殖系统沙眼衣原体感染很常见，会带来相当大的个人和公共卫生成本。需要有效的检测策略。
评估在六个月内，在全科医疗中开展机会性激励衣原体筛查项目的可行性。
本研究设计为初级保健中一项随机对照试验的试点。三家全科诊所被随机分配到干预组（两家诊所）和对照组。干预措施包括在为期三个月的“积极”干预期内进行诊所教育、自我样本采集以及诊所激励（资金和反馈）。在接下来的三个月期间停止反馈和教育。针对识别、检测、治疗和召回16至24岁的男性和女性患者，制定了特定诊所的护士或医生主导策略。主要结局指标是在引入干预措施后的六个月内，各诊所衣原体筛查率之间的差异，并对前一年的基线率进行控制。
在干预前一年，16至24岁患者的衣原体检测率在诊所就诊人数的2.9%至7.0%之间。在三个月时，干预诊所的筛查率高于对照诊所（p<0.001），但到六个月时，两家诊所的筛查率都恢复到干预前的水平。护士主导的筛查策略比医生主导的策略更有效（六个月内从35%降至5.5%）（医生主导策略六个月内从15%降至1.6%）（p = 0.04）。
通过一项包括诊所教育、反馈和自我样本采集的项目，对前往全科医生处就诊的16至24岁患者进行激励性机会性衣原体筛查，可以提高筛查率。
