Chlamydia Screening In General Practice Research Articles

Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model

BackgroundChlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15–24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims:Explore why the modified intervention did not increase screening across all general practices.Suggest recommendations for future intervention implementation.MethodsPhone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model.ResultsParticipants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers.ConclusionNot adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.

Increasing uptake of chlamydia screening in general practice

Chlamydia screening rates remain sub-optimal in the UK, but awareness raising using multi-media, plus training and education for clinicians, can improve uptake. Karen Strivens outlines findings of a pilot study to determine practical solutions in general practice. Chlamydia infection poses a huge challenge to public health and to the NHS, hence current policies to enhance screening in 15–24 year olds, the highest risk group ( Department of Health, 2009 ; National Chlamydia Screening Programme 2012 ; Public Health England, 2014 ). Despite efforts to reduce infection rates through mass media campaigns encouraging routine screening, rates remain sub-optimal and chlamydia infection continues to rise ( NHS Choices, 2010 ; Gobin et al, 2013 ). To address this, a pilot study was undertaken by a large general practice in north west England to improve screening uptake, using a three-pronged approach: raising awareness of chlamydia infection and available screening services via posters and text messages and online; providing practice staff with education and training to encourage uptake of screening in contraceptive and sexual health appointments; and initiating an evening drop-in service. Although the drop-in service did not achieve the anticipated attendance rate, findings highlighted a significant increase in chlamydia screening following the awareness-raising local multi-media campaign and education and training of staff.

P111 Perceptions of Chlamydia screening, contraception and HIV testing among 16–24 year old patients visiting a GP surgery

Background A complex intervention based on the Theory of Planned Behaviour significantly increased chlamydia screening in general practice (McNulty et al 2014). It may be more beneficial to extend this intervention to a broader sexual health offer including chlamydia testing, contraception advice and when appropriate, HIV testing (3Cs and HIV). Aim To determine young adults’ opinions of having a broader sexual health offer (3Cs and HIV) at their GP practice. Methods Thirty interviews were conducted with 9 male and 21 female patients, 16–24 years in English GP practices. Participants were interviewed immediately before or after a routine practice attendance of any type. Data was analysed using a thematic framework and using QSR Nvivo 10. Results Participants indicated that method of testing, timing and staff member approach were important aspects to chlamydia screening and contraception discussions. Participants displayed a clear preference for the GP practice over other sexual health service locations. Items most important to participants were convenience, reassurance, and that the sexual health discussion is appropriate and routine. Barriers identified were embarrassment, unease, lack of time, religion and concern of causing offence. Suggested facilitators include raising awareness, reassuring confidentiality, ensuring the discussion is facilitated by trust and professionalism at the end of the consultation. Conclusion The majority of participants are happy to be offered 3Cs and HIV at their GP surgery. Therefore, it is important for GP staff to recognise these preferences and ensure that the full 3Cs and HIV services are made available and offered to appropriate patients.

Tools to overcome potential barriers to chlamydia screening in general practice: Qualitative evaluation of the implementation of a complex intervention.

BackgroundChlamydia trachomatis remains a significant public health problem. We used a complex intervention, with general practice staff, consisting of practice based workshops, posters, computer prompts and testing feedback and feedback to increase routine chlamydia screening tests in under 25 year olds in South West England. We aimed to evaluate how intervention components were received by staff and to understand what determined their implementation into ongoing practice.MethodsWe used face-to-face and telephone individual interviews with 29 general practice staff analysed thematically within a Normalisation Process Theory Framework which explores: 1. Coherence (if participants understand the purpose of the intervention); 2. Cognitive participation (engagement with and implementation of the intervention); 3. Collective action (work actually undertaken that drives the intervention forwards); 4. Reflexive monitoring (assessment of the impact of the intervention).ResultsOur results showed coherence as all staff including receptionists understood the purpose of the training was to make them aware of the value of chlamydia screening tests and how to increase this in their general practice. The training was described by nearly all staff as being of high quality and responsible for creating a shared understanding between staff of how to undertake routine chlamydia screening.Cognitive participation in many general practice staff teams was demonstrated through their engagement by meeting after the training to discuss implementation, which confirmed the role of each staff member and the use of materials. However several participants still felt unable to discuss chlamydia in many consultations or described sexual health as low priority among colleagues. National targets were considered so high for some general practice staff that they didn’t engage with the screening intervention.Collective action work undertaken to drive the intervention included use of computer prompts which helped staff remember to make the offer, testing rate feedback and having a designated lead. Ensuring patients collected samples when still in the general practice was not attained in most general practices.Reflexive monitoring showed positive feedback from patients and other staff about the value of screening, and feedback about the general practices testing rates helped sustain activity.ConclusionsA complex intervention including interactive workshops, materials to help implementation and feedback can help chlamydia screening testing increase in general practices.

Using educational outreach and a financial incentive to increase general practices’ contribution to chlamydia screening in South-East London 2003–2011

BackgroundThe London Boroughs of Lambeth and Southwark have high levels of sexually transmitted infections including Chlamydia trachomatis. Modelling studies suggest that reductions in the prevalence of chlamydia infection will require a high level of population screening coverage and positivity among those screened. General practice has a potentially important role to play in delivering these levels of coverage since large numbers (up to 60%) of young people visit their general practice every year but previous work suggests that there are barriers to delivering screening in this setting. The aim of this study was to evaluate an intervention to increase chlamydia screening in general practice within Primary Care Trusts (PCTs) of Lambeth and Southwark, a strategy combining financial incentives and supportive practice visits to raise awareness and solve problems.MethodsData on age, gender, venue and chlamydia result for tests on under 25 s in Lambeth from 2003–11 was obtained from the National Chlamydia Screening Programme. We analysed the number and percentage of tests generated in general practice, and looked at the number of practices screening more than 10% of their practice cohort of 15–24 year olds, male/female ratio and positivity rates across other screening venues. We also looked at practices screening less than 10% and studied change over time. We compared data from Lambeth and Southwark with London and England. We also studied features of the level and type of educational and financial incentive interventions employed.ResultsChlamydia tests performed in general practice increased from 23 tests in 2003–4 to 4813 tests in 2010–11 in Lambeth. In Southwark they increased from 5 tests in 2003/04 to 4321 in 2010/11. In 2011, 44.6% of tests came from GPs in Lambeth and 46% from GP’s in Southwark. In Lambeth 62.7% of practices tested more than 10% of their cohort and in Southwark this was 55.8%. In Lambeth, postivity rate in 2010/11 was 5.8% in men and 6.0% in women. In Southwark positivity rate was 3.9% in men and 5.3% in women. In 2003/04 13% tests in general practice (Lambeth) were from men, this increased to 25% in 2010/11. In Southwark this increased from 20% in 2003/04 to 27.6% in 2010/11. We compared the results with London and national data and showed significant differences between GP testing in Lambeth and Southwark, and GP testing in London and the rest of England.ConclusionsGeneral practices can be important potential providers of chlamydia tests.With a combination of sustained support, financial incentives and feedback on performance, general practice may be able to test a large percentage of 15–24 year olds. General practice is also a potentially important provider of chlamydia tests to young men.

O8 The Australian chlamydia control effectiveness pilot (ACCEPt): first results from a randomised trial of annual chlamydia screening in general practice

BackgroundACCEPt is a cluster randomised controlled trial to evaluate annual opportunistic chlamydia screening for 16–29-year-old men and women in general practice (GP).ObjectiveTo report enrolment and baseline results.MethodsThe unit of randomisation...

Computer Reminders for Chlamydia Screening in General Practice: A Randomized Controlled Trial

Chlamydia notifications are increasing in Australia, and the use of a computer alert prompting general practitioners to test young women is a potential way to increase opportunistic chlamydia testing. The aim of this trial was to determine the effectiveness of a computer alert in general practice on chlamydia testing in young women. In 2006, clinics (n = 68) in Melbourne, Australia were cluster randomized into 2 groups: the intervention group received a computerized alert advising the general practitioner to discuss chlamydia testing with their patient which popped up when the medical record of a 16- to 24-year-old woman was opened; the control group received no alert. The outcome was whether or not that patient received a chlamydia test at the level of a single consultation with an eligible patient. A mixed effects logistic regression model adjusting for clustering was used to assess the impact of the alert on the proportion of women tested for chlamydia during the trial period. Testing increased from 8.3% (95% confidence interval (CI): 6.8, 9.8) to 12.2% (95% CI: 9.1, 15.3) (P < 0.01) in the intervention group, and from 8.8% (95% CI: 6.8, 10.7) to 10.6% (95% CI: 8.5, 12.7) (P < 0.01) in the control group. Overall, the intervention group had a 27% (OR = 1.3; 95% CI: 1.1, 1.4) greater increase in testing. The results of this study suggest that alerts alone may not be sufficient to get chlamydia testing levels up sufficiently high enough to have an impact on the burden of chlamydia in the population but that they could be included as part of a more complex intervention.

Overcoming the barriers to chlamydia screening in general practice--a qualitative study

There is low uptake of chlamydia screening in general practices registered with the English National Chlamydia Screening Programme (NCSP). Aims. To explore staff's attitudes and behaviour around chlamydia screening and how screening could be optimized in general practice. A qualitative study with focus groups and interviews, in general practices in seven NCSP areas. Twenty-five focus groups and 12 interviews undertaken with a purposively selected diverse group of high and low chlamydia-screening practices in 2006-08. Data were collected and analysed using a framework analytical approach. Higher screening practices had more staff with greater belief in patient and population benefits of screening and, as screening was a subjective norm, it was part of every day practice. Many staff in the majority of other practices were uncomfortable raising chlamydia opportunistically and time pressures meant that any extra public health issues covered within a consultation were determined by Quality Outcomes Framework (QOF) targets. All practices would value more training and feedback about their screening rates and results. Practices suggested that use of computer prompts, simplified request forms and more accessible kits could increase screening. Practice staff need more evidence of the value of opportunistic chlamydia screening in men and women; staff development to reduce the barriers to broaching sexual health; simpler request forms and easily accessible kits to increase their ability to offer it within the time pressures of general practice. Increased awareness of chlamydia could be attained through practice meetings, computer templates and reminders, targets and incentives or QOF points with feedback.

The experience of providing young people attending general practice with an online risk assessment tool to assess their own sexual health risk

BackgroundTargeted chlamydia screening has been advocated to reduce chlamydia associated reproductive sequelae. General practitioners are well positioned to play a major role in chlamydia control. The primary aim of this pilot study was to measure the effect of offering an online sexual health assessment tool, Youth Check Your Risk, on chlamydia testing rates among young people attending general practices. The secondary aim was to test the acceptability of the tool among general practitioners and young people.MethodsGeneral practitioners at three practices in Melbourne, Australia, referred patients aged 16 to 24 years to Youth Check Your Risk http://www.checkyourrisk.org.au for use post-consultation between March to October 2007. The proportion of young people tested for chlamydia before and during the implementation of the tool was compared. Acceptability was assessed through a structured interviewer-administered questionnaire with general practitioners, and anonymous online data provided by Youth Check Your Risk users.ResultsThe intervention did not result in any significant increases in the proportion of 16 to 24 year old males (2.7% to 3.0%) or females (6.3% to 6.4%) tested for chlamydia. A small increase in the proportion of 16 to 19 year old females tested was seen (4.1% to 7.2%). Of the 2997 patients seen during the intervention phase, 871 (29.1%) were referred to Youth Check Your Risk and 120 used it (13.8%). Major reasons for low referral rates reported by practitioners included lack of time, discomfort with raising the issue of testing, and difficulty in remembering to refer patients.ConclusionOffering an online sexual risk assessment tool in general practice did not significantly increase the proportion of young people tested for chlamydia, with GPs identifying a number of barriers to referring young people to Youth Check Your Risk. Future interventions aimed at increasing chlamydia screening in general practice with the aid of an online risk assessment tool need to identify and overcome barriers to testing.

Role of the general practitioner in testing for genital Chlamydia trachomatis infection: an analysis of enhanced surveillance data

To examine the relationship between genital chlamydia testing by healthcare providers and patient demographic characteristics in Tasmania, Australia, from 2001 to 2007. Analysis of enhanced surveillance data for genital Chlamydia trachomatis infections notified to the Tasmanian Communicable Diseases Prevention Unit between 1 January 2001 and 31 December 2007. General practitioners identify most cases of genital chlamydia infection, irrespective of patient age, gender, indigenous status or urban status. Tests that are performed for screening purposes identify the largest number of cases in females, particularly in very young females. In males, tests performed due to the presence of clinical symptoms identify the majority of cases. However, tests performed for the purposes of contact tracing also identify a substantial burden of genital chlamydia infection, particularly in males. The present study demonstrates the critical role the general practitioner has in the identification of genital chlamydia infection. Opportunistic screening for genital chlamydia, including in the context of contact tracing, is an essential clinical activity that results in the identification of substantial numbers of cases of infection. Policy makers and public health practitioners should support general practice screening initiatives and remove the barriers to genital chlamydia screening in general practice.

What needs to change to increase chlamydia screening in general practice in Australia? The views of general practitioners

BackgroundAustralia is considering implementing a chlamydia screening program in general practice. The views of general practitioners (GPs) are necessary to inform the design of the program. This paper aimed to investigate Australian GPs' views on how chlamydia screening could work in the Australian context.MethodsThis project used both qualitative interviews and a quantitative questionnaire. GPs were randomly selected from a national database of medical practitioners for both the qualitative and quantitative components. Semi-structured interviews were conducted with GPs and a thematic analysis conducted. The results of the interviews were used to design a quantitative postal questionnaire for completion by a larger sample of GPs. Up to three reminders were sent to non-responders.ResultsTwenty one GPs completed an interview and 255 completed the postal questionnaire. The results of the postal survey were in strong concordance with those of the interview. GPs identified a number of barriers to increased screening including lack of time, knowledge of GPs and the public about chlamydia, patient embarrassment and support for partner notification. GPs felt strongly that screening would be easier if there was a national program and if the public and GPs had a greater knowledge about chlamydia. Incentive payments and mechanisms for recall and reminders would facilitate screening. Greater support for contact tracing would be important if screening is to increase.ConclusionChlamydia screening in general practice is acceptable to Australian GPs. If screening is to succeed, policy makers must consider the facilitators identified by GPs.

Strategies used to increase chlamydia screening in general practice: a qualitative study

To explore strategies used by chlamydia screening co-ordinators and practice staff to implement genital chlamydia screening within general practices. Qualitative phenomenological study using individual semi-structured telephone interviews. Screening co-ordinators were selected purposively in Phase 1 and 2 areas of the Department of Health National Chlamydia Screening Programme in England, where there was significant screening in general practice. Open questions were asked about: the factors that determined high chlamydia screening rates; maintaining motivation for screening; and strategies to increase screening in general practices. Co-ordinators reported that successful screening practices had a champion who drove the screening process forward. These practices had normalized screening, so all at-risk patients were offered opportunistic screening whenever they attended. This was facilitated by a variety of time-saving methods including computer prompts, test kits in the reception area, youth clinics and receptionist involvement. Chlamydia screening was sustained through frequent reminders, newsletters containing chlamydia screening rates, and advertising to the 'at-risk' population from the screening team. Co-ordinators' enthusiasm and project management skills were as important as sexual health experience. Co-ordinators reported that to facilitate chlamydia screening across all practices, screening could be included in the General Medical Services (GMS) contract, and a higher national profile was needed amongst health professionals and the public. All practice staff need to be encouraged to become champions of the chlamydia screening programme through education, especially aimed at older clinicians and receptionists. The National Health Service should consider including chlamydia screening in the GMS contract. Increased public awareness will allow screening to be undertaken more quickly and by non-medical staff.

Take the sex out of STI screening! Views of young women on implementing chlamydia screening in General Practice

BackgroundAustralia is developing a chlamydia screening program. This study aimed to determine the attitudes of young women to the introduction of chlamydia screening in Australian General Practice.MethodsIn-depth face-to-face interviews with 24 young women from across Victoria, Australia, attending a randomly selected sample of general practices.ResultsYoung women reported that they would accept age-based screening for chlamydia in general practice, during both sexual-health and non-sexual-health related consultations. Trust in their general practitioner (GP) was reported to be a major factor in the acceptability of chlamydia screening. The women felt chlamydia screening should be offered to all young women rather than targeted at "high risk" women based on sexual history and they particularly emphasised the importance of normalising chlamydia screening. The women reported that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test. Some reported that they would lie if asked how many partners they had hadConclusionWomen do not want a sexual history taken when being asked to have a chlamydia test while attending a general practitioner. They prefer the offer of chlamydia screening to be based on age rather than assessment of sexual risk. Chlamydia screening needs to be normalised and destigmatised.

Screening for Chlamydia trachomatis at the time of routine Pap smear in general practice: a cluster randomised controlled trial

To determine whether asking general practitioners to offer chlamydia screening at the same time as Pap screening increases chlamydia screening rates. A pragmatic cluster randomised controlled trial. Doctors from 31 general practices in the Australian Capital Territory performing more than 15 Pap smear screens per year, and all women aged 16-39 years attending those practitioners between 1 November 2004 and 31 October 2005. Doctors in the intervention practices were asked to routinely offer combined chlamydia and Pap screening to eligible women; doctors in the control practices were asked to implement screening guidelines based on a risk assessment of the individual patient (ie, usual practice). Chlamydia screening rate per visit. There were 26 876 visits by eligible women during the study period: 16 082 to intervention practices and 10 794 to control practices. Chlamydia screening occurred during 6.9% (95% CI, 6.5%-7.3%) of visits to intervention practices and 4.5% (95% CI, 4.1%-4.9%) of visits to control practices. After controlling for clustering and potential confounders, there were twofold greater odds of chlamydia screening occurring during a visit by an eligible woman to an intervention practice than to a control practice (adjusted odds ratio, 2.1 [95% CI, 1.3-3.4]). Combining chlamydia and Pap screening increases the rate of chlamydia screening in general practice. Implementing this approach would require little additional infrastructure support in settings where a cervical screening program already exists.

Attitudes to chlamydia screening in general practice among Australian university students: a pilot study

Chlamydia screening of sexually active young people in general practice is key to the Australian National Sexually Transmissible Infections Strategy 2005-2008. Overseas research indicates that young people have positive attitudes towards opportunistic screening by a general practitioner (GP). This pilot study aims to investigate the attitudes of Australian university students towards chlamydia screening in primary care. Students (16-25 years) attending a class in one of three faculties at the University of Sydney participated by completing a questionnaire, which collected information about demographics, sexual history, chlamydia knowledge, attitudes towards and preferences for chlamydia screening. One hundred and eighty-five students (78% female) returned questionnaires (participation rate 92%). Arts students were younger, more likely to be sexually active and to report having little or no knowledge of chlamydia. Males in the study were less likely to have had sex as a group compared to the group of females in the sample. Science students were also less likely to have had sex compared to their counterparts in other faculties. Seventy-six percent of students were comfortable with opportunistic testing for chlamydia by their GP. Reasons for not being comfortable included 'don't think I'm at risk' (65%) and 'not comfortable discussing sexual matters with my GP' (38%). Although comfortable with GP-based testing, the likelihood of being tested in the upcoming year for most students was low, as was personal concern about chlamydia infection. Findings suggest that the most at risk group for chlamydia infection is not well educated about their risk of infection. The limited numbers of tests among sexually active individuals in this sample indicate that health practitioners are not screening this high-risk group for chlamydia infection.

Strategies used to increase chlamydia screening in general practice: a qualitative study

Strategies used to increase chlamydia screening in general practice: a qualitative study

56. TAKE THE SEX OUT OF STI SCREENING! VIEWS OF GPS AND YOUNG WOMEN ON IMPLEMENTING CHLAMYDIA SCREENING IN AUSTRALIA

In-depth face to face interviews were carried out with a randomly selected sample of 20 General Practitioners (GPs) and 24 young women from across Victoria. We aimed to determine the attitudes of GPs and young women to chlamydia screening, what systems and education would be required to support chlamydia screening in general practice in Australia and in particular to explore how young women feel about being asked to test for chlamydia when they attend a GP for any reason. Both GPs and young women accept age-based screening for chlamydia and screening during a sexual health related consultation in general practice. Both feel that a large scale public education program, encompassing the high prevalence of chlamydial infection in young people in Australia, the asymptomatic nature of infection and the potential consequences if untreated, will be essential in ensuring the success of a chlamydia screening program in Australia. For the women, trust in their GP, was a major factor in the acceptability of chlamydia screening. They also felt chlamydia screening should be offered to all young women rather than targeted at 'high risk' women based on sexual history and they particularly emphasised the importance of normalising chlamydia screening. Women were clear that they did not want to be asked to provide a sexual history as part of being asked to have a chlamydia test. This finding has not been widely published in the literature and is worthy of comment. There is considerable evidence suggesting that GPs also regard sexual history taking as a barrier to STI testing in general practice. Chlamydia is an STI and notification and treatment of sexual partners is important. Understanding these concepts promotes young women's acceptance of chlamydia screening. However, is a detailed sexual history really an important precursor to a chlamydia test? Our study suggests maybe not.

Chlamydia screening in general practice: views of professionals on the key elements of a successful programme

ObjectivesChlamydia trachomatis is a common sexually transmitted infection with serious consequences if not treated. Chlamydia screening pilots in England have established feasibility in primary care but there are currently no...

Sexual health in primary care: acceptability of providing a urine sample for chlamydia screening in GP attendees aged 25 or under

Gott and Hinchcliffe1 found a number of barriers inhibiting older people from seeking treatment for sexual problems in primary care. We recently investigated a different sexual issue in younger people visiting their GP. Our aim was to find the acceptability to GP attendees aged 25 or under of being asked to provide a urine specimen for chlamydia screening. In Nov 2003 we conducted a cross sectional, confidential questionnaire survey of all patients aged 25 or under attending an inner London GP surgery in one week. 54 patients aged 25 or under attended the surgery; all were given an information sheet. 14 did not wish to take part (response rate 74%, 40/54). The age range of the 40 participants was 16–25, the mean age was 22 and 18% were male (7/40). 25 of the participants were white (63%), 6 participants were black Caribbean, 3 were Black African, 1 participant was Asian, and the remaining 5 participants were of other ethnic groups. Men were significantly less likely than women to accept the offer of screening: 50% (7/14) of men agreed to take part compared to 83% (33/40) of women (P 0.05). No participants were found to be positive for chlamydia. The response rate suggests that opportunistic chlamydia screening in general practice is acceptable and feasible. This is in line with the Department of Health chlamydia screening pilots in Portsmouth and Wirral.2 Almost 20 000 people were tested during the one-year study. 50% of the eligible female population in the target age range (16–24) were screened and the prevalence of infection in under 25s tested in primary care was 13%. By contrast we did not find any chlamydia positives in our study. This could be because of our small sample size or because in the pilot screening programmes screening was opportunistic and selective rather than consecutive. Therefore it is likely that the GPs (who were paid to take part) screened mainly high risk or symptomatic individuals. More research is needed to determine whether opportunistic screening in primary care throughout the UK would be practical and financially beneficial for the NHS in the long term. The recently implemented DOH phased roll out system aims to answer these questions.

Opportunistic screening for Chlamydia in general practice: the experience of health professionals.

Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call-recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery.