GPs polled on chlamydia initiative
Chlamydia notifications have been increasing in both Western Australia and the catchment area covered by the South Metropolitan Area Health Service (SMAHS).
In 2010, 3,686 cases of chlamydia were notified in the SMAHS catchment, an increase of 20% from 2009 and accounting for 44% of all notifiable diseases. Crude notification rates in the SMAHS catchment (438 per 100,000 population) and WA (442 per 100,000) were higher than national rates (352 per 100,000). Notification rates were highest among young people, with 2,001 per 100,000 in the 20 to 24 years age group and 1,841.4 per 100,000 in the 15 to 19 years group.1
The South Metropolitan Public Health Unit (SMPHU) chlamydia protocol previously targeted all notifications in people under 16 years and older cases in high-risk populations, with phone calls to notifying doctors and follow up as required.2 However, there was no intervention for 16 to 21 year olds, for whom chlamydia notification rates were the highest. In 2010, the SMPHU commenced an initiative to target this age group through correspondence with their notiifying general practitioner. The following is an evaluation of that initiative.
This intervention was targeted at GPs in SMAHS who notified a case of chlamydia in a person aged 16 to 21 years. Doctors excluded from the intervention were those who specialised in sexual health (such as sexual health and family planning clinics) and those whose patient had already been identified and followed up as a high-risk case (such as an antenatal patient or somebody with a co-infection).
The intervention was in the form of an SMPHU mail-out which included a letter that could be filed in the patient’s notes that provided information on treatment of chlamydia and other sexually transmitted infections (STIs) and STI screening and contact tracing. A standard treatment protocol for STIs was also included.
The survey was designed to seek feedback from GPs on the usefulness of this intervention. A random sample of GPs was taken from chlamydia notifications to the Western Australia Notifiable Infectious Disease Database (WANIDD) for patients in the SMAHS catchment for a 3-month period from the week beginning 4 July 2011 to the week ending 2 October 2011. A standardised questionnaire was used for all GPs. Questionnaires were delivered by fax or email along with copies of the chlamydia correspondence as a memory prompt.
GPs who did not respond within 2 weeks were contacted by telephone. Cases where a practitioner had not engaged in the survey after 3 attempts, were deemed non responses.
From a total of 264 GPs in the target group, a sample of 150 GPs were selected to survey. Of those, 8 were no longer working at the practice or were on extended leave, 20 declined to participate and 15 were not followed up according to protocol (i.e. the questionnaire was faxed to the surgery but no attempt was made to follow up with a telephone call). These GPs were excluded from the analysis, leaving 107 GPs or 71% of the 150 selected for the survey.
Most GPs surveyed (89%) were aware of the chlamydia mail out sent by the SMPHU upon notification of a case and 72% found the correspondence useful. Participants found the STI standard treatment protocol to be the most useful resource (66%), followed by the STI testing advice (52%). Some GPs also requested that patient information be sent along with GP information.
Half the GPs said the information assisted with the recall and treatment of the patient and half felt it helped with patient education and counselling. Only a third, however, reported that the letters helped them with contact tracing.
Feedback from many GPs indicated that they assumed the Department of Health followed up with contact tracing for all chlamydia cases.
The majority of GPs (70%) said they would like to continue to receive SMPHU correspondence regarding chlamydia. A number said the initial information was useful but that they would like to receive further letters only if there were new developments in the management of chlamydia or STIs. A number also indicated they would like further information on other notifiable diseases.
As a result of the survey it was recommended that:
- communication with GPs around their role in chlamydia contact tracing be improved
- GPs be referred to the WA Department of Health website for further information on notifiable diseases
- GPs be given the option to decline further correspondence through phone or fax back
- the targeted intervention continue.
- Internal document of Disease Control Section, South Metropolitan Public Heath Unit (SMPHU), WA DOH. July 2011. Review of Notifiable Diseases in the South Metropolitan Area Health Service – 2010.
- Internal document of Disease Control Section, South Metropolitan Public Heath Unit (SMPHU), WA DOH. July 2011.Chlamydia Follow-up Prioritisation Protocol.