基层医疗中采用集中式护士主导的电话服务管理衣原体和淋病感染：混合方法评估。

Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation.

机构信息

Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.

National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.

出版信息

BMC Fam Pract. 2020 Dec 10;21(1):265. doi: 10.1186/s12875-020-01329-0.

DOI:10.1186/s12875-020-01329-0

PMID:33302884

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7731735/

Abstract

BACKGROUND

Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme's centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care.

METHODS

Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care.

RESULTS

One thousand one hundred fifty-four Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn't negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results.

CONCLUSION

Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.

摘要

背景

在英国，高达 18%的生殖器衣原体感染和 9%的淋病感染是在初级保健中诊断出来的。有证据表明，相当一部分病例没有按照国家指南进行适当管理。随着性传播感染的增加和抗生素耐药性的出现，及时和适当的治疗是当务之急。我们研究了将国家衣原体筛查计划的集中式、护士主导的电话管理（NLTM）作为初级保健中诊断出的所有衣原体和淋病病例管理的一种选择的可行性和可接受性。

方法

在布里斯托尔的 11 个实践中进行了一项随机可行性试验，并进行了嵌套的定性研究。在干预实践中，患者和医疗保健提供者（HCPs）可以选择 NLTM 或常规护理，用于所有接受衣原体和淋病检测的患者。在对照实践中，患者接受常规护理。

结果

在 6 个月的研究期间，共进行了 1154 次衣原体/淋病检测，衣原体阳性率为 2.6%，淋病阳性率为 0.8%。NLTM 管理了 335 名患者。对 16 名 HCP（11 名全科医生，5 名护士）和 12 名患者（8 名女性）进行了访谈。HCP 对 NLTM 持积极态度，对伙伴通知服务表示欢迎，但要求对患者的管理提供更及时的反馈。向患者解释 NLTM 并没有对咨询产生负面影响。患者发现 NLTM 可以接受，更方便，并比常规护理提供更大的匿名性。患者喜欢收到有关阴性结果的短信，并重视与性健康专家谈论阳性结果。