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

Jeremy Horwood,Peter Muir,Emer Brangan,Petra Manley,John Macleod,Paddy Horner,Paul North

doi:10.1186/s12875-020-01329-0

Abstract

BackgroundUp 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.MethodsRandomised 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.ResultsOne 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.ConclusionExtension 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.

Highlights

Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care
In control practices 228 of349 tests were submitted amongst recruited patients, mean age 32 years, 121 (34.7%) of patient tests were excluded from the study: 62 patient ineligible, 5 assigned to the incorrect study arm and 54 declined permission for use of anonymised medical records
In intervention practices 436 of805 tests were submitted amongst recruited patients, mean age 34.1 years, 369 (45.8%) patient tests were excluded from the study: 77 clinically inappropriate, 39 patient ineligible, 238 not consented to receive NLTM and 15 were assigned to the incorrect study arm

Summary

Introduction

Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Chlamydia trachomatis and Neisseria gonorrhoeae are the two most commonly diagnosed bacterial sexually transmitted infections (STIs) in England, with 218,095 and 56,259 diagnoses reported in 2018, a 6 and 26% increase since 2017 [1]. Referral of confirmed gonorrhoea cases to a genitourinary medicine (GUM) clinic, due to the complexities of management, is strongly recommended [11, 12] These recommendations are essential to prevent reinfection, onward transmission, treatment failure, morbid sequelae, minimise the pool of infection in the population and avert further emergence of anti-microbial resistance [10, 11]

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Discussion

Conclusion