Provision of chlamydia testing, and training of primary health care staff about chlamydia testing, across four European countries

BMC Public Health

Cliodna McNulty⁶  Pia P Touboul¹  Brigitte Dunais¹  Johan Hedlund³  Hans Fredlund⁴  Ruth R Kalda⁵  Claire Rugman⁶  Ellie J Ricketts⁶  Anneli Uusküla² 

[1] Nice University Hospital, Nice, France;Department of Public Health, University of Tartu, Tartu, Estonia;Office for Communicable Disease Control, Uppsala County Council, Uppsala, Sweden;Clinical Microbiology, Örebro University Hospital, Örebro, Sweden;Polyclinic, University of Tartu, Tartu, Estonia;Public Health England, Primary Care Unit, Microbiology, Gloucestershire Royal Hospital, Gloucester, UK

关键词: Europe;    General practice;    Training;    Testing;    Chlamydia;   

Others  :  1123033
DOI  :  10.1186/1471-2458-14-1147

 received in 2014-01-17, accepted in 2014-10-27,  发布年份 2014

【 摘 要 】

Background

The objectives of this study were to describe and compare chlamydia testing provided by general practitioners (GPs) in four selected European countries with well-developed primary health care systems and high reported chlamydia rates; we aimed to compare contrasting countries where chlamydia testing is provided by GPs (England, Sweden) with countries where primary care chlamydia testing is absent or very limited (France, Estonia).

Methods

For data generation a structured questionnaire was developed and secondary data sources were searched. The questionnaire developed by the research team allowed a systematic approach to analysing chlamydia care (including testing in general practice) and the gathering of relevant data.

Results

There were no significant differences in the burden of the disease or the type of general practice care provision in the study countries. In all four countries, testing for chlamydia (with nucleic acid amplification test, NAAT) is available in the public sector, a substantial proportion (>60%) of young people aged 16–25 years visit their general practitioner (GP) annually, and reimbursement for chlamydia testing costs to the relevant parties (GPs in England, Sweden and Estonia; and patients in France) by the national health insurance system or its equivalent.

In countries where chlamydia testing is provided by GPs (England, Sweden) a national strategy or plan on STI control that specifically mentions chlamydia was in force, chlamydia care guidelines for GPs were in place and STI management was more firmly established in the GP residency training curriculum, either formally (England) or informally (Sweden), than in the other countries.

Conclusion

Future research on the effectiveness of chlamydia screening (also in the context of general practice care) and program provision should reflect national needs and the prevention of complications.

【 授权许可】

   
2014 Uusküla et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]European Centre for Disease Prevention and Control: Annual epidemiological report Reporting on 2010 surveillance data and 2011 epidemic intelligence data. Stockholm: ECDC; 2012.
• [2]Centers for Disease Control and Prevention: Sexually Transmitted Disease Surveillance 2010. Atlanta: U.S: Department of Health and Human Services; 2011.
• [3]European Centre for Disease Prevention: (Draft) technical report: Chlamydia Control in Europe Survey of Member States. Stockholm: ECDC; 2013.
• [4]European Centre for Disease Prevention and Control: GUIDANCE Chlamydia control in Europe. Stockholm: ECDC; 2009. available at http://ecdc.europa.eu/en/publications/publications/0906_gui_chlamydia_control_in_europe.pdf webcite
• [5]Shaw K, Coleman D, O’Sullivan M, Stephens N: Public health policies and management strategies for genital Chlamydia trachomatis infection. Risk Manage Healthc Policy 2011, 4:57-65.
• [6]Kalwij S, French S, Mugezi R, Baraitser P: Using educational outreach and a financial incentive to increase general practices’ contribution to chlamydia screening in South-East London 2003–2011. BMC Public Health 2012, 12:802. BioMed Central Full Text
• [7]National Chlamydia Screening Programme Standards. 6th edition. 2012. available at http://www.chlamydiascreening.nhs.uk/ps/resources/core-requirements/NCSP%20Standards%206th%20Edition_October%202012.pdf webcite
• [8]Guy RJ, Ali H, Liu B, Poznanski S, Ward J, Donovan B, Kaldor J, Hocking J: Efficacy of interventions to increase the uptake of chlamydia screening in primary care: a systematic review. BMC Infect Dis 2011, 11:211. BioMed Central Full Text
• [9]Ginige S, Fairley CK, Hocking JS, Bowden FJ, Chen MY: Interventions for increasing chlamydia screening in primary care: a review. BMC Public Health 2007, 7:95. BioMed Central Full Text
• [10]McNulty CA, Thomas M, Bowen J, Buckley C, Charlett A, Gelb D, Foy C, Sloss J, Smellie S: Interactive workshops increase chlamydia testing in primary care–a controlled study. Fam Pract 2008, 25(4):279-86.
• [11]Roland M, Guthrie B, Thome DC: Primary Medical Care in the United Kingdom. J Am Board Fam Med 2012, 25(1):S6-S11.
• [12]Samuelson M, Bourgueil Y: Country Case Study: Primary care in France. In Presentation at the Conference Improving primary care in Europe and the US. Italy: Towards patient-centered, proactive and coordinated systems of care; 2008.
• [13]Glenngård AH, Hjalte F, Svensson M, Anell A, Bankauskaite V: Health systems in transition. Sweden: WHO, on behalf of the European Observatory on Health Systems and Policies; 2005.
• [14]European Centre for Disease Prevention and Control: Annual Epidemiological Report 2012. Reporting on 2010 surveillance data and 2011 epidemic intelligence data. Stockholm; 2013. available at http://ecdc.europa.eu/en/publications/Publications/Annual-Epidemiological-Report-2012.pdf webcite
• [15]European Centre for Disease Prevention: Technical report re view of chlamydia control activities in EU countries. Stockholm: ECDC; 2008.
• [16]Goulet V, de Barbeyrac B, Raherison S, Prudhomme M, Semaille C, Warszawski J: CSF group: Prevalence of Chlamydia trachomatis: results from the first national population-based survey in France. Sex Transm Infect 2010, 86(4):263-70.
• [17]Low N, McCarthy A, Macleod J, Salisbury C, Campbell R, Roberts TE, Horner P, Skidmore S, Sterne JA, Sanford E, Ibrahim F, Holloway A, Patel R, Barton PM, Robinson SM, Mills N, Graham A, Herring A, Caul EO, Davey Smith G, Hobbs FD, Ross JD, Egger M, Chlamydia Screening Studies Project Group: Epidemiological, social, diagnostic and economic evaluation of population screening for genital chlamydial infection. Health Technol Assess 2007, 11(8):1-165. iii-iv, ix-xii
• [18]Bracebridge S, Bachmann MO, Ramkhelawon K, Woolnough A: Evaluation of a systematic postal screening and treatment service for genital Chlamydia trachomatis, with remote clinic access via the internet: a cross-sectional study, East of England. Sex Transm Infect 2012, 88(5):375-81.
• [19]Uusküla A, Kals M, Denks K, Nurm U, Kasesalu L, Dehovitz J, McNutt LA: The prevalence of chlamydial infection in Estonia: a population-based survey. Int J STD AIDS 2008, 19(7):455-8.
• [20]British Association Sexual Health and HIV 2006: UK National Guideline for the Management of Genital Tract Infection with Chlamydia trachomatis. 2006. http://www.bashh.org/documents/65.pdf webcite
• [21]Sweden STI management guidelines. available at http://www.slf.se/Foreningarnasstartsidor/Intresseforening/Smittskyddslakarforeningen/Smittskyddsblad-/Klamydialakarinformation-2010-02-15/ webcite, in Swedish
• [22]Estonian union for sexually transmitted infections: STI management guidelines 2011. 2011. http://www.eusti.ee/STI_ravijuhis_2011.pdf webcite
• [23]Haute autorite de sante 2010 Diagnostic biologique de l’infection à Chlamydia trachomatis. 2012. http://www.has-sante.fr/portail/upload/docs/application/pdf/2012-02/synthese_chlamydia_trachomatis.pdf webcite
• [24]Haute autorite de sante 2003: Evaluation du depistage des infections uro-genitales basses à chlamydia trachomatis en France. 2003. http://www.has-sante.fr/portail/upload/docs/application/pdf/Chlamydia_tome2_synth.pdf webcite
• [25]Smittspårning vid sexuellt överförbara sjukdomar: Recommendations on partner notification. Swedish: National Board of Health; 2007.
• [26]Salisbury C, Macleod J, Egger M, McCarthy A, Patel R, Holloway A, Ibrahim F, Sterne JA, Horner P, Low N: Opportunistic and systematic screening for chlamydia: a study of consultations by young adults in general practice. Br J Gen Pract 2006, 56(523):99-103.
• [27]Tekkel M, Veideman T: Health Behavior among Estonian Adult Population, 2012. Natl Inst Health Dev 2012. available at https://intra.tai.ee/images/prints/documents/136479842690_TKU_2012.pdf webcite
• [28]Beck F, Richard JB: Les Comportements de santé des jeunes. Analyses du Baromètre santé 2010. Saint-Denis: Inpes, coll. Baromètres santé 2013, 344. available at http://www.inpes.sante.fr/CFESBases/catalogue/pdf/1452.pdf webcite
• [29]PHPSU/HIAT/12341: Public Health Outcomes Framework. Department of Health, Public Health Policy and Strategy Unit; 2013. available at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/263658/2901502_PHOF_Improving_Outcomes_PT1A_v1_1.pdf webcite
• [30]Public Health Outcomes Framework 2013 to 2016 and technical updates. England: Department of Health; available at https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency webcite
• [31]National Chlamydia Screening Programme. http://www.chlamydiascreening.nhs.uk/ webcite
• [32]Dehne KL, Riedner G, Neckermann C, Mykyev O, Ndowa FJ, Laukamm-Josten U: A survey of STI policies and programmes in Europe: preliminary results. Sex Transm Infect 2002, 78:380-384.
• [33]McNulty CA, Hogan AH, Ricketts EJ, Wallace L, Oliver I, Campbell R, Kalwij S, O’Connell E, Charlett A: Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour. Sex Transm Infect 2013. Sep 4. [Epub ahead of print]
• [34]Perkins E, Carlisle C, Jackson N: Opportunistic screening for Chlamydia in general practice: the experience of health professionals. Health Soc Care Community 2003, 11(4):314-20.
• [35]Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL: Primary care: is there enough time for prevention? Am J Public Health 2003, 93(4):635-41.
• [36]Zyzanski SJ, Stange KC, Langa D, Flocke SA: Trade-offs in high-volume primary care practice. J Fam Pract 1998, 46:397-402.