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Chlamydia Screening

Chlamydia Screening. Ellie Ricketts SW Chlamydia Support. Aim. The aim of this session is to feedback results from the 2009 NCSP Practitioner Questionnaire Equip you with the information needed to support chlamydia screening in your practice. Questionnaire Responses.

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Chlamydia Screening

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  1. Chlamydia Screening Ellie Ricketts SW Chlamydia Support

  2. Aim The aim of this session is to feedback results from the 2009 NCSP Practitioner Questionnaire Equip you with the information needed to support chlamydia screening in your practice.

  3. Questionnaire Responses Pre letter sent to 622 NCSP registered practices in South West. (All practices registered for at least 6 months at Apr 2009), asking them to nominate 3 members of staff (1 Dr, 1 Nurse and 1 Receptionist), to complete a questionnaire about the NCSP. 301 surgeries responded to the letter asking for questionnaires (48% of sample population). Of the 301 surgeries, 288 returned at least one questionnaire (60% response rate). In total 873 Questionnaires were sent to practice staff

  4. Sample 471 participants Majority of respondents female (93%) Job type: 27% (n=124) GP 50% (n= 232) Practice/other nurse inc HCA’s 11% (n=51) Receptionist 12% other (n=54) (practice managers, various non-patient facing admin and phlebotomists)

  5. Staff of all grades reported that they felt that extra training on • The microbiology & epidemiology of chlamydia • Knowledge about treatment and how to deal with a positive result Results - Knowledge

  6. Chlamydia trachomatis Bacterial Sexually Transmitted Infection Easily Treated

  7. Rates of diagnoses Males Females Routine GUM clinic returns

  8. Signs & Symptoms Women > 80% asymptomatic post coital or intermenstrual bleeding lower abdominal pain purulent vaginal discharge mucopurulent cervicitis and/or contact bleeding dysuria Men > 50% asymptomatic urethral discharge dysuria (pain on passing urine) (extent of severity may vary)

  9. Transmission vaginal sexual intercourse anal sexual intercourse oral-genital contact mutual touching sharing of sex toys

  10. Relationship between genital chlamydial infection, pelvic inflammatory disease and the sequelae of PID Genital chlamydial infection 10 - 40% of untreated infections PID Ectopic pregnancy (~47%?) Female Infertility (~20%?) HPA Communicable Disease Surveillance Centre

  11. Why target under 25’s?

  12. Physiology Older cervix Columnar epithelial cells have retreated into endo-cervical canal Young cervix Abundant columnar epithelial cells Sexually Transmitted Diseases, 3rd Edition. Holmes, KK, et al., eds. (USA: McGraw-Hill)

  13. Include… All ♀and ♂ under 25 years old The partner(s) of any person with a positive chlamydia test - regardless of age Assess need for repeat screening – recommend screen annually or at partner change

  14. Under 16’s Research has shown that nearly a third of young people are sexually active before they reach 16yrs Wellings et al. (2001) Sexual Behaviour in Britain: early heterosexual experience. Lancet 358: 1843-50

  15. Results - Normalise The majority of respondents felt if screening was made ‘the norm’ it would make screening easier

  16. Which test / sample? Men - first catch urine Women - self-taken vulvo-vaginal swab (vvs) or first catch urine

  17. Accuracy

  18. Timing of tests Annual screen or screen at partner change

  19. Attendance On average in the < 25 yrs age group 60% men 75% women visit the GP for a consultation at least annually Salisbury et al. Brit J Gen Pract 2006:56:99-103

  20. Your surgery data

  21. Results - targets 75% (n=213) of clinicians, 94% (n=32) of receptionists and 89% (n=16) of practice managers think they do not know the proportion of the target sample the DoH wants to be screened 5% (n=13) of clinicians, no receptionists, and 6% (n=1) of practice managers gave a response in the correct range (i.e. 11-20%)

  22. NCSP TARGET 2010/2011 =35% (76 patients) 35% = 2 screens per week

  23. A lot of respondents felt young people don’t want to be asked as part of a consultation. They thought it would either • Offend the patient • Would make the patient anxious Result

  24. What do young people think about being asked?

  25. The surgery was the most convenient place “I’m just more familiar, with my doctor so I’d feel better about coming somewhere that I knew rather than having to go somewhere else. It’s kind of embarrassing or bad enough as it is, so you want to go somewhere you’re familiar with I think.”

  26. They would accept an opportunistic screen if offered by a doctor or nurse “..just by promoting it more positively, it’s just that they just need to get across its good for their health anyway but, …. doctor or staff need to talk to them.”

  27. Patients prefer staff who display a non-judgemental attitude “afraid that the doctors and nurses are gonna judge them, that, that’s what I think” “It depends on the other person, really what they tell you about it or speak to you, how they speak to you about it.”

  28. The majority of the sample reported a preference for taking the sample at the surgery rather than doing it at home “yeah, do it while you are here, why not, because if they’re taking it home you’re not going to bring it back”

  29. Young people are happy to take information or kits from receptionists “…I suppose its handy, …. Its letting you know, what it involves and that should have like a self (test), you just take one.”

  30. Most clinical staff were concerned that there isn’t enough time in a consultation or • That they don’t know how to raise the subject Results - Time

  31. How do I raise the subject?

  32. Scenario 1 50 seconds

  33. Scenario 2 1 min 40 secs

  34. Scenario 3 1min 55 sec

  35. Scenario 4 4 seconds

  36. “We like to think as a practice, once we decide to take on board something that’s going to help the clients or the patients, then the whole system is set. Like the reception is aware, all the clinical staff are aware and everyone will do whatever is necessary.” Results - Whole team approach

  37. Chlamydia Support Team Teaching sessions GP led posters & invitations Web site – screening data and newsletter Advice and support via email Help to set up computer prompts and templates Help to initiate other mechanisms to increase screening

  38. www.swchlamydiasupport.org

  39. Contact us at info@swchlamydiasupport.org katie@swchlamydiasupport.org angela@swchlamydiasupport.org ellie@swchlamydiasupport.org Telephone: 08454 225068 Website: www.swchlamydiasupport.org

  40. Summary Staff require more knowledge to feel able to offer chlamydia testing Screening needs to be normalised – offer to everybody! All staff need to know (and understand) the target Young people want to be asked It doesn’t need to take a lot of time Whole team approach

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