Screening for chlamydia in Australian general practice – what works?
Most chlamydia is diagnosed in the general practice setting in Australia, but although 80% of young adults attend their general practitioner (GP) annually, general practice chlamydia testing rates remain low. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) aims to evaluate whether annual chlamydia testing for 16-29 year olds attending general practice can reduce chlamydia prevalence in the population.
ACCEPt is a randomised controlled trial. To facilitate increased chlamydia testing, ACCEPt intervention clinics were offered computer alerts, incentive payments to GPs and practice nurses for each chlamydia test conducted, quarterly audit and feedback on testing performance to individual GPs, GP and practice nurse training, and patient recall and reminders for follow up testing. ACCEPt drew on Normalisation Process Theory (NPT) to guide the design of the intervention and ensure it was successfully embedded into routine clinical practice.
143 clinics servicing over 70,000 16-29 year olds were recruited across Victoria, Queensland, NSW and South Australia. Testing rates almost doubled in intervention clinics compared with control clinics (RR=1.9; 95%CI: 1.8, 2.0). The longer the intervention was in place, the higher the testing rate for both females and males. Following 3 years of intervention, the numbers of 16-29 year olds who were screened annually for chlamydia rose to approximately 27% of women and 15% of men in intervention clinics.
How sustainable are these improvements in chlamydia testing? To investigate this, clinics have now been re-randomised into a follow-up study to determine which of the interventions has the most impact on chlamydia testing. Interventions will be removed in a systematic way while chlamydia testing rates continue to be monitored. The results of this follow-up study may have implications for many interventions in the primary care setting.