Amersham Vale Practice, Waldron Health Centre, London SE14 6LD, United Kingdom.
BMC Public Health. 2012 Sep 18;12:802. doi: 10.1186/1471-2458-12-802.
The London Boroughs of Lambeth and Southwark have high levels of sexually transmitted infections including Chlamydia trachomatis. Modelling studies suggest that reductions in the prevalence of chlamydia infection will require a high level of population screening coverage and positivity among those screened. General practice has a potentially important role to play in delivering these levels of coverage since large numbers (up to 60%) of young people visit their general practice every year but previous work suggests that there are barriers to delivering screening in this setting. The aim of this study was to evaluate an intervention to increase chlamydia screening in general practice within Primary Care Trusts (PCTs) of Lambeth and Southwark, a strategy combining financial incentives and supportive practice visits to raise awareness and solve problems.
Data on age, gender, venue and chlamydia result for tests on under 25 s in Lambeth from 2003-11 was obtained from the National Chlamydia Screening Programme. We analysed the number and percentage of tests generated in general practice, and looked at the number of practices screening more than 10% of their practice cohort of 15-24 year olds, male/female ratio and positivity rates across other screening venues. We also looked at practices screening less than 10% and studied change over time. We compared data from Lambeth and Southwark with London and England. We also studied features of the level and type of educational and financial incentive interventions employed.
Chlamydia tests performed in general practice increased from 23 tests in 2003-4 to 4813 tests in 2010-11 in Lambeth. In Southwark they increased from 5 tests in 2003/04 to 4321 in 2010/11. In 2011, 44.6% of tests came from GPs in Lambeth and 46% from GP's in Southwark. In Lambeth 62.7% of practices tested more than 10% of their cohort and in Southwark this was 55.8%. In Lambeth, postivity rate in 2010/11 was 5.8% in men and 6.0% in women. In Southwark positivity rate was 3.9% in men and 5.3% in women. In 2003/04 13% tests in general practice (Lambeth) were from men, this increased to 25% in 2010/11. In Southwark this increased from 20% in 2003/04 to 27.6% in 2010/11. We compared the results with London and national data and showed significant differences between GP testing in Lambeth and Southwark, and GP testing in London and the rest of England.
General practices can be important potential providers of chlamydia tests.With a combination of sustained support, financial incentives and feedback on performance, general practice may be able to test a large percentage of 15-24 year olds. General practice is also a potentially important provider of chlamydia tests to young men.
伦敦兰贝斯和南华克区的性传播感染水平较高，包括沙眼衣原体。模型研究表明，要降低衣原体感染的流行率，需要高水平的人群筛查覆盖率和筛查阳性率。由于大量（高达 60%）年轻人每年都会去看全科医生，因此全科医生在提供这些覆盖率方面具有潜在的重要作用，但之前的研究表明，在这种环境下提供筛查存在障碍。本研究旨在评估一项在兰贝斯和南华克初级保健信托（PCT）中增加全科医生进行衣原体筛查的干预措施，该策略结合经济激励措施和支持性的实践访问，以提高认识和解决问题。
从 2003-11 年全国衣原体筛查计划中获取兰贝斯 25 岁以下人群的年龄、性别、地点和衣原体检测结果数据。我们分析了在全科医生中进行的检测数量和百分比，并观察了筛查 15-24 岁人群超过 10%的实践数量、男女比例和其他筛查场所的阳性率。我们还观察了筛查不足 10%的实践，并研究了随时间的变化。我们将兰贝斯和南华克的数据与伦敦和英格兰的数据进行了比较。我们还研究了所采用的教育和经济激励措施的水平和类型的特征。
兰贝斯的全科医生进行的衣原体检测从 2003-4 年的 23 次增加到 2010-11 年的 4813 次。南华克的检测次数从 2003/04 年的 5 次增加到 2010/11 年的 4321 次。2011 年，兰贝斯 44.6%的检测来自全科医生，南华克为 46%。兰贝斯有 62.7%的实践检测了超过 10%的队列，南华克为 55.8%。兰贝斯 2010/11 年的阳性率为男性 5.8%，女性 6.0%。南华克的阳性率为男性 3.9%，女性 5.3%。2003/04 年，全科医生进行的检测中有 13%（兰贝斯）来自男性，这一比例在 2010/11 年增加到 25%。南华克的这一比例从 2003/04 年的 20%增加到 2010/11 年的 27.6%。我们将结果与伦敦和全国数据进行了比较，结果表明兰贝斯和南华克的全科医生检测结果与伦敦和英格兰其他地区的全科医生检测结果存在显著差异。
全科医生可以成为衣原体检测的重要潜在提供者。通过持续的支持、经济激励措施和绩效反馈，全科医生可能能够对大量 15-24 岁人群进行检测。全科医生也是为年轻男性提供衣原体检测的潜在重要提供者。
