Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation

Abstract Background Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme’s centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. Methods Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care. Results One thousand one hundred fifty-four Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn’t negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results. Conclusion Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.

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Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation

10.21203/rs.3.rs-23099/v3 ◽

2020 ◽

Author(s):

Emer Brangan ◽

Jeremy Horwood ◽

Petra Manley ◽

Paddy Horner ◽

Peter Muir ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Health Care Providers ◽

Partner Notification ◽

Text Message ◽

Feasibility Trial ◽

Chlamydia Screening ◽

Care Providers ◽

National Guidelines ◽

Sexually Transmitted

Abstract Background: Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme’s centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. Methods: Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care.Results: 1154 Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn’t negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results.Conclusion: Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.

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Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation

10.21203/rs.3.rs-23099/v4 ◽

2020 ◽

Author(s):

Jeremy Horwood ◽

Emer Brangan ◽

Petra Manley ◽

Paddy Horner ◽

Peter Muir ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Health Care Providers ◽

Partner Notification ◽

Text Message ◽

Feasibility Trial ◽

Chlamydia Screening ◽

Care Providers ◽

National Guidelines ◽

Sexually Transmitted

Abstract Background: Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme’s centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. Methods: Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care.Results: 1154 Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn’t negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results.Conclusion: Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.

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Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation

10.21203/rs.3.rs-23099/v2 ◽

2020 ◽

Author(s):

Emer Brangan ◽

Jeremy Horwood ◽

Petra Manley ◽

Paddy Horner ◽

Peter Muir ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Health Care Providers ◽

Partner Notification ◽

Text Message ◽

Feasibility Trial ◽

Chlamydia Screening ◽

Care Providers ◽

National Guidelines ◽

Sexually Transmitted

Abstract Background: Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme’s centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. Methods: Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care. Results: During the 6-month study, 1154 Chlamydia/gonorrhoea tests took place, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female, 4 male). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn’t negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results. Conclusion: Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primary care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.

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Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation

10.21203/rs.3.rs-23099/v5 ◽

2020 ◽

Author(s):

Jeremy Horwood ◽

Emer Brangan ◽

Petra Manley ◽

Paddy Horner ◽

Peter Muir ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Health Care Providers ◽

Partner Notification ◽

Text Message ◽

Feasibility Trial ◽

Chlamydia Screening ◽

Care Providers ◽

National Guidelines ◽

Sexually Transmitted

Abstract Background: Up to 18% of genital Chlamydia infections and 9% of Gonorrhoea infections in England are diagnosed in Primary Care. Evidence suggests that a substantial proportion of these cases are not managed appropriately in line with national guidelines. With the increase in sexually transmitted infections and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority. We investigated feasibility and acceptability of extending the National Chlamydia Screening Programme’s centralised, nurse-led, telephone management (NLTM) as an option for management of all cases of chlamydia and gonorrhoea diagnosed in Primary Care. Methods: Randomised feasibility trial in 11 practices in Bristol with nested qualitative study. In intervention practices patients and health care providers (HCPs) had the option of choosing NLTM or usual care for all patients tested for Chlamydia and Gonorrhoea. In control practices patients received usual care.Results: 1154 Chlamydia/gonorrhoea tests took place during the 6-month study, with a chlamydia positivity rate of 2.6% and gonorrhoea positivity rate of 0.8%. The NLTM managed 335 patients. Interviews were conducted with sixteen HCPs (11 GPs, 5 nurses) and 12 patients (8 female). HCPs were positive about the NLTM, welcomed the partner notification service, though requested more timely feedback on the management of their patients. Explaining the NLTM to patients didn’t negatively impact on consultations. Patients found the NLTM acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message regarding a negative result and valued talking to a sexual health specialist about positive results.Conclusion: Extension of this established NLTM intervention to a greater proportion of patients was both feasible and acceptable to both patients and HCP, could provide a better service for patients, whilst decreasing primacy care workload. The study provides evidence to support the wider implementation of this NLTM approach to managing chlamydia and gonorrhoea diagnosed in primary care.

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The management of sexually transmitted infections: a scoping survey in primary care

BJGP Open ◽

10.3399/bjgpopen18x101639 ◽

2019 ◽

Vol 3 (2) ◽

pp. bjgpopen18X101639 ◽

Cited By ~ 1

Author(s):

Jayshree Dave ◽

John Paul ◽

Julie Johnson ◽

Jane Hutchinson ◽

Glenn Phiri ◽

...

Keyword(s):

Primary Care ◽

Sexually Transmitted Infections ◽

Nucleic Acid Amplification Test ◽

National Standards ◽

Nucleic Acid Amplification ◽

Chlamydia Screening ◽

National Guidelines ◽

Sexually Transmitted ◽

Patient Request ◽

Vaginal Swabs

BackgroundNational guidelines for sexually transmitted infections (STIs) in primary care exists but their management is uncertain.AimTo assess the management of STIs against national standards in primary care.Design & settingA questionnaire based study in London and Brighton. The survey was conducted in 2015 following reorganisation of sexual health services in England.MethodQuestionnaires were sent to GPs in London and Brighton about testing for STIs, treatment for gonorrhoea, specialist advice, and referral services.ResultsOf 119 GPs who responded, most expressed confidence in treating chlamydia (n = 105/119, 88%), trichomonas (n = 81/119, 68%), and herpes (n = 82/119, 69%) but not gonorrhoea (n = 32/119, 27%). Most referred cases of syphilis (n = 92/119, 77%) and genital warts (83/119, 70%) to genito-urinary medicine (GUM) as per guidance. Most GPs tested for gonorrhoea on patient request (n = 95/119, 80%), in tandem with chlamydia screening (n = 89/119, 75%), because of high risk status (n = 85/119, 71%) and genital symptoms (n = 108/119, 91%). Some GPs (n = 22/119, 18%) sampled urine for culture, 53/119 (45%) provided high vaginal swabs (HVS), and 28/119 (24%) provided self-taken vulvovaginal swabs (STVVS) for culture. These samples are not appropriate for gonococcal culture and not processed in the laboratory. Urethral swabs for men and endocervical swabs (ECS) are recommended for gonococcus culture. Over half (n = 60/102, 59%) of GPs did not treat gonorrhoea but some prescribed cefixime, ciprofloxacin, or azithromycin. Eighty-seven per cent (n = 104/119) sought advice from GUM, and 83/103 (81%) referred gonorrhoea nucleic acid amplification test (NAAT)-positive patients.ConclusionThere is scope for improvement of STIs management in primary care to ensure that patients are optimally investigated, treated, and referred.

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Nutrition in Primary Health Care: Using a Delphi Process To Design New Interdisciplinary Services

Canadian Journal of Dietetic Practice and Research ◽

10.3148/67.0.2006.s14 ◽

2006 ◽

Vol 67 (S1) ◽

pp. S14-S29 ◽

Cited By ~ 12

Author(s):

Paula Brauer ◽

Linda Dietrich ◽

Bridget Davidson ◽

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Administrative Support ◽

Care Service ◽

Delphi Process ◽

Care Providers ◽

Modified Delphi ◽

Nutrition Services ◽

Key Features

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

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A web-based intervention to increase weight loss treatment initiation: results of a cluster randomized feasibility and acceptability trial

Translational Behavioral Medicine ◽

10.1093/tbm/ibz143 ◽

2019 ◽

Cited By ~ 2

Author(s):

Megan A McVay ◽

William S Yancy ◽

Gary G Bennett ◽

Erica Levine ◽

Seung-Hye Jung ◽

...

Keyword(s):

Primary Care ◽

Weight Loss ◽

Treatment Initiation ◽

Primary Care Providers ◽

Feasibility Trial ◽

Care Providers ◽

Behavioral Weight Loss ◽

Weight Loss Treatment ◽

Primary Care Patients ◽

Cluster Randomized

Abstract Evidence-based behavioral weight loss treatment is under-utilized. To increase initiation of treatment, we developed a single-session, online, primary care-based intervention (“mobilization tool”). We evaluated the mobilization tool's acceptability for primary care patients with obesity, trial design feasibility, and signal of an effect of the tool on treatment initiation. In this cluster randomized feasibility trial, primary care providers (PCPs) were randomized to a mobilization tool or comparator tool arm. Patients with obesity and a scheduled appointment with a randomized PCP were assigned to complete the mobilization or comparator tool prior to their appointment. The online mobilization tool asks patients to answer questions about a variety of weight-related topics and then provides automated, tailored feedback that addresses psychosocial determinants of weight loss treatment initiation. The comparator tool provided a nontailored description of treatments. All participants were offered free enrollment in behavioral weight loss treatments. Six PCPs were randomized. Sixty patients (57% female; 66% white; aged 55 ± 13 years) participated in this study of 296 contacted for eligibility evaluation (20.2%). Six-month follow-up assessments were completed by 65% (22/34) of the mobilization and 73% (19/26) of comparator tool participants. Participants completing the acceptability survey reported that the mobilization tool was usable, enjoyable, informative, and useful. Weight loss treatment was initiated by 59% (n = 19) of mobilization and 33% (n = 8) of comparator tool participants. The mobilization tool shows promise for increasing treatment initiation among primary care patients, which may increase population weight loss. Trial Registration: Clinicaltrials.gov identifier: NCT02708121.

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Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

Palliative & Supportive Care ◽

10.1017/s1478951520000164 ◽

2020 ◽

Vol 18 (6) ◽

pp. 658-661

Author(s):

Mafalda Lemos Caldas ◽

Miguel Julião ◽

Ana João Santos ◽

Harvey Max Chochinov

Keyword(s):

Primary Care ◽

Health Care Providers ◽

Cross Sectional Study ◽

Care Providers ◽

Sectional Study ◽

Clinical Tool ◽

Cross Sectional ◽

Old Patients ◽

Promising Tool ◽

Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

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