在初级保健中实施教育干预以提高医护人员主动进行 HIV 检测的理由、设计和初步结果。
Rationale, design and initial results of an educational intervention to improve provider-initiated HIV testing in primary care.
机构信息
Department of Internal Medicine, Division of Infectious Diseases, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, the Netherlands.
出版信息
Fam Pract. 2021 Jul 28;38(4):441-447. doi: 10.1093/fampra/cmaa139.
OBJECTIVES
In the Netherlands, general practitioners (GPs) perform two-thirds of sexually transmitted infection (STI) consultations and diagnose one-third of HIV infections. GPs are, therefore, a key group to target to improve provider-initiated HIV testing. We describe the design and implementation of an educational intervention to improve HIV testing by Amsterdam GPs and explore trends in GPs' testing behaviour.
METHODS
Interactive sessions on HIV and STI using graphical audit and feedback started in 2015. Participating GPs developed improvement plans that were evaluated in follow-up sessions. Laboratory data on STI testing by Amsterdam GPs from 2011 to 2017 were collected for graphical audit and feedback and effect evaluation. The primary outcome was the HIV testing rate: number of HIV tests per 10 000 person-years (PY). Secondary endpoints were chlamydia and gonorrhoea testing rates and HIV positivity ratios.
RESULTS
Since 2015, 41% of GPs participated. HIV testing rate declined from 2011 to 2014 (from 175 to 116 per 10 000 PY), more in women than men (176 to 101 versus 173 to 132), and stabilized from 2015 to 2017. The HIV positivity ratio declined from 0.8% in 2011 to 0.5% in 2017. From 2011 to 2017, chlamydia and gonorrhoea testing rates declined in women (from 618 to 477 per 10 000 PY) but remained stable in men (from 270 to 278).
CONCLUSIONS
The stabilization of the downward trend in HIV testing coincided with this educational intervention. Follow-up data are needed to formally assess the intervention's impact on GP testing behaviour whilst considering contextual factors and secular trends.
目的
在荷兰，全科医生（GP）承担了三分之二的性传播感染（STI）咨询工作，并诊断了三分之一的 HIV 感染病例。因此，GP 是一个关键的目标群体，需要通过他们来提高提供者发起的 HIV 检测。我们描述了一项教育干预措施的设计和实施情况，以改善阿姆斯特丹 GP 对 HIV 的检测，并探讨了 GP 检测行为的趋势。
方法
自 2015 年以来，采用图形审计和反馈的方式开展了有关 HIV 和性传播感染的互动式课程。参与的 GP 制定了改进计划，并在后续的会议上进行了评估。收集了 2011 年至 2017 年阿姆斯特丹 GP 的 STI 检测实验室数据，用于图形审计和反馈以及效果评估。主要结果是 HIV 检测率：每 10000 人年（PY）的 HIV 检测数量。次要终点是衣原体和淋病检测率和 HIV 阳性率。
结果
自 2015 年以来，有 41%的 GP 参与了该项目。HIV 检测率从 2011 年到 2014 年下降（从 175 下降到 116 每 10000 PY），女性下降幅度大于男性（176 下降到 101 比 173 下降到 132），并从 2015 年到 2017 年稳定下来。HIV 阳性率从 2011 年的 0.8%下降到 2017 年的 0.5%。从 2011 年到 2017 年，女性的衣原体和淋病检测率下降（从 618 下降到 477 每 10000 PY），但男性的检测率保持稳定（从 270 下降到 278）。
结论
HIV 检测呈下降趋势的稳定与这项教育干预措施的实施相一致。需要进一步的随访数据，以正式评估该干预措施对 GP 检测行为的影响，同时考虑到背景因素和时间趋势。
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