Nurse-led telephone-based management of chlamydia & gonorrhoea diagnosed in primary care: Pilot trial qualitative evaluation

Talk Code: 
EP3D.03
Presenter: 
Emer Brangan
Co-authors: 
Brangan E (1,2), Manley P (3), Macleod J (2), Horwood J (1,2)
Author institutions: 
1 NIHR CLAHRC West, 2 School of Social & Community Medicine - University of Bristol, 3 Public Health South West

Problem

The NHS has made substantial investment in encouraging increased testing for common STI in primary care however there is little evidence that this has led to improved patient outcomes. A key issue is appropriate management of positive cases and their sexual contacts in the community where 40% of tests are taken. Evidence suggests that many GPs have neither the experience nor the resources to manage STI effectively, in particular to trace and treat sexual partners to avoid re-infection and continued spread in the community.

Approach

A nurse-led telephone based service was developed where all patients testing positive for chlamydia and gonorrhoea in primary care can be offered treatment and partner notification independent of their GP. We conducted a pilot trial to examine feasibility and acceptability to patients and practitioners. This presentation reports on the findings of the qualitative evaluation. Interviews were conducted with eighteen Health Care Practitioners (HCP) from the eight practices in the trial intervention arm, and twelve patients who both consented and declined consent to trial participation. Purposive sampling selected participants in order to attempt to capture maximum variation in views and experiences. Data were digitally recorded, transcribed verbatim and analysed thematically supported by qualitative data analysis software NVivo10.

Findings

HCP and patients considered the intervention and trial acceptable and feasible. HCP perceived the intervention as likely to benefit patients through faster and more convenient delivery of results and management, and more comprehensive follow-up including partner notification. Patients also expected faster and more convenient delivery of results and management, and valued the involvement of a specialist nurse. Patients felt that the intervention would lessen the embarrassment and stigma of STI management. In general, patients were happy for follow-up information to be extracted from their medical records, providing their anonymity was maintained.HCP retained a strong sense of personal responsibility for the care of patients whose tests they had initiated, and it was important that they had timely access to details of their patients’ management. Research consent procedures were often experienced as problematic by HCP, particularly in the early stages of the trial, and by HCP who were not regularly recruiting for the trial. Consented patients had often not fully comprehended the details of the research or intervention. Interviewed patients nevertheless found it acceptable to have been included in the study.

Consequences

The qualitative evaluation findings suggested that the intervention could contribute to improving patient outcomes and enhance patient experience of the management of chlamydia and gonorrhoea diagnosed in primary care. The findings support the proposal to carry out a larger scale cluster randomised trial, and also provide evidence to refine the trial design to increase the feasibility and acceptability to both HCP and patients.

Submitted by: 
Emer Brangan
Funding acknowledgement: 
Sexual Health Improvement for Populations and Patients Health Integration Team (SHIPP HIT), NIHR Collaborations for Leadership in Applied Health Research and Care West (CLAHRC West), NIHR Health Protection Research Unit (HPRU)