Chlamydia Screening

SW Chlamydia Support

Ellie RickettsSW 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 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


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)


Results - KnowledgeResults - Knowledge

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


Chlamydia trachomatis

Bacterial Sexually Transmitted

Infection Easily Treated


Rates of diagnoses

Routine GUM clinic returns

Males Females

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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)



Transmission

vaginal sexual intercourse

anal sexual intercourse oral-genital contact mutual touching sharing of sex toys


Relationship between genital chlamydial infection, pelvic inflammatory disease and the sequelae of PID

Female Infertility (~20%?)

Genital chlamydial infection

10 - 40% of untreated infections

PID

Ectopic pregnancy (~47%?)

HPA Communicable Disease Surveillance Centre


Why target under 25’s?

Physiology

Presentation

Epidemiology

Behaviour


Physiology

Older cervixColumnar 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)


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


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


Results - Normalise

The majority of respondents felt if screening was made ‘the norm’ it would make screening easier


Which test / sample?

Men - first catch urine

Women - self-taken vulvo-vaginal swab (vvs) or first catch urine


Accuracy

Sensitivity Specificity

Urine ♂ - first catch urine 95% 99%

Self-taken VulvoVaginal Swab

97% 95%

Urine ♀ - first catch urine 92% 95%


Timing of tests

Annual screen

or screen at partner change


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


Your surgery data

Number of 15-24 year olds registered at the

surgery

217

Attendance

Average attendance

in 1 year

146 = (74%)


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%)


NCSP TARGET 2010/2011

=35% (76 patients)

35% = 2 screens per week


ResultResult

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



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.”


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.”


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.”


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”


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.”


Results - TimeResults - Time

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



Scenario 1

50 seconds


Scenario 2

1 min 40 secs


Scenario 3

1min 55 sec


Scenario 4

4 seconds


“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


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


www.swchlamydiasupport.org


Contact us at

[email protected]@swchlamydiasupport.org

[email protected] [email protected]

Telephone: 08454 225068

Website: www.swchlamydiasupport.org


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

Chlamydia Screening

Documents