GP Management of sexually-acquired Chlamydia infections

in North Queensland

Dr. Tracy Cheffins MBBS MPH FRACGP FAFPHM

Scottish School of Primary CareEdinburgh 2011

Townsville, Australia

The Problem

• Prevalence of Chlamydia increasing• Most research done in public clinics• Most treatment done by private GPs• Control requires treatment of partner contacts• Evidence of inconsistent GP management of

contact tracing

The Place

The Research Team

• Dr. Tracy Cheffins, NQPBRN*• Ms. Margaret Spillman, NQPBRN• A/Prof. Clare Heal, School of Medicine and Dentistry

(Mackay)• Dr. Monika Buhrer-Skinner, Qld Health sexual health unit• A/Prof. Sarah Larkins, School of Medicine and Dentistry• GPs and nurses, 9 General Practices in North Queensland

*(North Queensland Practice Based Research Network)

The Questions

• Do GPs manage Chlamydia according to Queensland Health sexual health guidelines?

• Why do GPs refer for Chlamydia testing?

• What do GPs tell their patients?

The Methods

• Practice nurse audit of 12 months of positive Chlamydia cases diagnosed by practice GPs (n=176)

• Three month collection of “reason for referral” data for all Chlamydia tests referred by practice GPs (n=521)

• GP questionnaire on usual management and preferred contact tracing methods (n=35)

The Workforce

Results (1) - Audit

N=176

Prescribed medication

Results (1) - Audit

Results of follow up Chlamydia tests

Results (2) - Referrals

N=521

Reasons for GP referral for Chlamydia test

Results (3) - GP surveyN=35

51%43%

6%

same or next day within 2-4 daysnext available appt

26%

40%

23%

11%

always sometimes seldom never

How often GPs treat patients with symptoms of Chlamydia prior to receiving test results

How quickly GPs ask to see patients after a positive test result

Results (3) - GP survey

Length of time GPs advised

patients to use condoms after treatment for

Chlamydia infection.

Results (3) - GP survey

Length of time to repeat test following

treatment of Chlamydia infection.

Preferred methods for contact tracing ranked from most to least

• Electronic contact methods• Printed resources• GP access to an external contact tracer• Direct register referral of ALL cases to contact tracer• GP referral of ALL cases to contact tracer

• Very little support for the status quo (<10%)

Tropical Cyclone Yasi

NQPBRN

• 15 practices have participated in research (approx 45 GPs)

• Academic coordinator (0.4 FTE)• Research worker (0.5 FTE)• Started 2007 with RACGP grant for road trauma research study• Funded by Australian Dept of Health and Ageing PHCRED*

capacity building grant since 2008• Five completed studies• Two studies for completion 2011

*(Primary Health Care Research Evaluation and Development program)

Completed Studies

• Rural GP management of chronic road crash trauma cases – GP survey

• GP management of acute otitis externa – audit, prospective data collection, GP survey

• Evaluation of over 75 years health assessments in General Practice – 2 projects - GP audit and patient survey

• Parent vaccination study – cross sectional patient survey with follow-up by practice nurses.

The Strategy

• Work with nurses rather than GPs• Pay practices for nurse research time• Provide research training for nurses• Visit practices (with food) to recruit GPs and share results• Ensure CPD points available for research• Support network members to attend conferences, write

papers• Gentle persuasion and personal touch

The Visit