澳大利亚全科医疗中执业护士进行衣原体检测的情况：对益处、障碍和促进因素的定性研究
Practice nurse chlamydia testing in Australian general practice: a qualitative study of benefits, barriers and facilitators.
作者信息
Lorch Rebecca, Hocking Jane, Guy Rebecca, Vaisey Alaina, Wood Anna, Lewis Dyani, Temple-Smith Meredith
机构信息
The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
出版信息
BMC Fam Pract. 2015 Mar 14;16:36. doi: 10.1186/s12875-015-0251-8.
BACKGROUND
Chlamydia infection is a significant public health issue for young people; however, testing rates in Australian general practice are low. Practice nurses (PNs) could have an important role in contributing to increasing chlamydia testing rates. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of PNs in maximising testing rates. In order to assess the scope for PN involvement, we aimed to explore PN's views in relation to involvement in chlamydia testing in general practice.
METHODS
Semi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt. Interview data was thematically analysed using a conventional content analysis approach.
RESULTS
The participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement, such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor. An alleviation of doctors' workloads and expansion of the nurse's role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered barriers to chlamydia testing, along with concerns around privacy in the "small town" rural settings of the general practices. Some felt negative GP attitudes as well as issues with funding for PNs' work could also be barriers. The provision of training and education, streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing.
CONCLUSION
This study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients, doctors, PNs and the community. Strategies to overcome identified barriers and facilitate their involvement must be further explored.
背景
衣原体感染是年轻人面临的一个重大公共卫生问题；然而，澳大利亚全科医疗中的检测率较低。执业护士在提高衣原体检测率方面可能发挥重要作用。澳大利亚衣原体控制效果试点项目（ACCEPt）是一项针对全科医疗中16至29岁人群进行年度检测的大型整群随机对照试验，首次调查了执业护士在最大化检测率方面的作用。为了评估执业护士参与的范围，我们旨在探讨执业护士对参与全科医疗中衣原体检测的看法。
方法
2011年6月至2012年4月期间，对参与ACCEPt的23名执业护士进行了有目的抽样的半结构化访谈。采用传统内容分析法对访谈数据进行主题分析。
结果
我们研究中的参与者支持执业护士在衣原体检测中发挥更大作用，并确定了这种参与给患者带来的一些益处，比如检测服务得到改善，检测机会更多，患者与护士交流比与医生交流感觉更自在。在诊所层面，减轻医生工作量和扩大护士职责也被视为益处。时间和工作量限制通常被认为是衣原体检测的障碍，同时在全科医疗“小镇”农村环境中对隐私的担忧也存在。一些人认为全科医生的消极态度以及执业护士工作资金问题也可能是障碍。提供培训和教育、简化诊所衣原体检测流程以及改变病理检查申请流程将有助于护士参与衣原体检测。
结论
本研究表明，执业护士可以在提高全科医疗中衣原体检测率方面发挥作用，他们的参与可能给患者、医生、执业护士和社区带来潜在益处。必须进一步探索克服已确定障碍并促进其参与的策略。
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