Public Health England Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, and Cardiff University, Cardiff, UK.
Sex Transm Infect. 2014 May;90(3):188-94. doi: 10.1136/sextrans-2013-051029. Epub 2013 Sep 4.
To determine if a structured complex intervention increases opportunistic chlamydia screening testing of patients aged 15-24 years attending English general practitioner (GP) practices.
A prospective, Cluster Randomised Controlled Trial with a modified Zelen design involving 160 practices in South West England in 2010. The intervention was based on the Theory of Planned Behaviour (TPB). It comprised of practice-based education with up to two additional contacts to increase the importance of screening to GP staff and their confidence to offer tests through skill development (including videos). Practical resources (targets, posters, invitation cards, computer reminders, newsletters including feedback) aimed to actively influence social cognitions of staff, increasing their testing intention.
Data from 76 intervention and 81 control practices were analysed. In intervention practices, chlamydia screening test rates were 2.43/100 15-24-year-olds registered preintervention, 4.34 during intervention and 3.46 postintervention; controls testing rates were 2.61/100 registered patients prior intervention, 3.0 during intervention and 2.82 postintervention. During the intervention period, testing in intervention practices was 1.76 times as great (CI 1.24 to 2.48) as controls; this persisted for 9 months postintervention (1.57 times as great, CI 1.27 to 2.30). Chlamydia infections detected increased in intervention practices from 2.1/1000 registered 15-24-year-olds prior intervention to 2.5 during the intervention compared with 2.0 and 2.3/1000 in controls (Estimated Rate Ratio intervention versus controls 1.4 (CI 1.01 to 1.93).
This complex intervention doubled chlamydia screening tests in fully engaged practices. The modified Zelen design gave realistic measures of practice full engagement (63%) and efficacy of this educational intervention in general practice; it should be used more often.
The trial was registered on the UK Clinical Research Network Study Portfolio database. UKCRN number 9722.
确定一项结构化的综合干预措施是否能增加为 15-24 岁就诊于英国全科医生（GP）诊所的患者提供机会性衣原体筛查检测。
这是一项前瞻性、基于群组的随机对照试验，采用改良的 Zelen 设计，涉及 2010 年英格兰西南部的 160 家诊所。干预措施基于计划行为理论（TPB）。它包括以实践为基础的教育，最多增加两次额外的接触，以提高 GP 工作人员对筛查的重视程度，并通过技能发展（包括视频）增强他们提供检测的信心。实用资源（目标、海报、邀请卡、电脑提醒、包括反馈的通讯）旨在积极影响工作人员的社会认知，增加他们的检测意愿。
对 76 家干预诊所和 81 家对照诊所的数据进行了分析。在干预诊所中，衣原体筛查检测率为每 100 名 15-24 岁登记患者在干预前为 2.43 例，干预期间为 4.34 例，干预后为 3.46 例；对照组在干预前的检测率为每 100 名登记患者 2.61 例，干预期间为 3.0 例，干预后为 2.82 例。在干预期间，干预组的检测率是对照组的 1.76 倍（95%CI 1.24 至 2.48）；这一情况持续了 9 个月（1.57 倍，95%CI 1.27 至 2.30）。在干预前，每 1000 名 15-24 岁登记患者中，干预组的衣原体感染检出率从 2.1/1000 上升到干预期间的 2.5，而对照组为 2.0/1000 和 2.3/1000（干预组与对照组的估计率比为 1.4（95%CI 1.01 至 1.93））。
这项复杂的干预措施使完全参与的实践中衣原体筛查检测增加了一倍。改良的 Zelen 设计提供了实践充分参与的现实措施（63%）和这种教育干预在全科实践中的疗效；应该更经常地使用它。
该试验在英国临床研究网络研究组合数据库中注册。英国临床研究网络编号 9722。
