Improving management of sexually transmitted infections in primary care: feasibility and acceptability of a new patient management tool for clinicians
Sally B. Rose 1 2 , Susan M. Garrett 1 , Susan R. H. Pullon 11 Department of Primary Health Care and General Practice, University of Otago, Wellington, PO Box 7343, Wellington South, New Zealand.
2 Corresponding author. Email: sally.rose@otago.ac.nz
Journal of Primary Health Care 13(2) 171-179 https://doi.org/10.1071/HC20051
Published: 24 May 2021
Journal Compilation © Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Routinely following an evidence-based clinical pathway of care for bacterial sexually transmitted infections (STIs) such as chlamydia or gonorrhoea is important to help reduce the spread of infections, prevent reinfections and avoid associated health complications.
AIM: To develop an easy-to-use tool for routine use by primary care clinicians to ensure best practice management of patients tested for and diagnosed with chlamydia or gonorrhoea.
METHODS: The tool (a MedTech Advanced Form) was developed in consultation with seven primary care clinicians and included different tabs for use during the STI care pathway (testing, treatment, advice, partner notification and follow up) with clickable links to relevant online resources. The tool was trialled over 3 months by 19 clinicians in three Wellington primary care clinics – two youth health and a student health service. Outcome measures were frequency of use, completeness of fields related to best practice care and clinician acceptance of the tool (from focus group feedback).
RESULTS: The tool was used for approximately one in four patients who were tested during the trial period, with ‘forgetting’ reported as the most common reason for non-use. Clinician views about the tool were favourable, with most indicating they would like to continue use and would recommend it to colleagues. Documentation of best practice care was excellent; fields to record reasons for testing, discussion of sexual history, provision of treatment and advice given were used for most patients for whom the form was completed.
CONCLUSIONS: Inclusion of this STI management tool in the electronic patient records system appeared to improve primary care clinicians’ delivery and documentation of best practice sexual health care at a practice level. Wider use of a modified version of this tool could facilitate more comprehensive best practice management of bacterial STIs.
KEYwords: Best practice management; Chlamydia trachomatis; Neisseria gonorrhoeae; primary care clinicians; sexually transmitted infections.
References
[1] The Institute of Environmental Science and Research Ltd. New Zealand Sexually Transmitted Infection (STI) Surveillance Dashboard 2021; 2021. [cited 2021 April 21]. Available from: https://www.esr.cri.nz/our-services/consultancy/public-health/sti/[2] Stamm WE, editor. Chlamydia trachomatis infections of the adult. New York: McGraw-Hill; 2008.
[3] Centers for Disease Control and Prevention (CDC). Gonorrhoea - CDC fact sheet. Facts and Brochures. Atlanta, Georgia: CDC; 2021. [cited 2021 February 2]. Available from: http://www.cdc.gov/std/gonorrhea/STDFact-gonorrhea-detailed.htm
[4] Centers for Disease Control and Prevention (CDC). Chlamydia - CDC fact sheet. Facts and Brochures. Atlanta, Georgia: CDC; 2021. [cited 2021 February 2]. Available from: http://www.cdc.gov/std/chlamydia/STDFact-chlamydia-detailed.htm
[5] Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019; 97 548–62P.
| Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016.Crossref | GoogleScholarGoogle Scholar | 31384073PubMed |
[6] Price MJ, Ades AE, Soldan K, et al. The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis. Health Technol Assess. 2016; 20 1–250.
| The natural history of Chlamydia trachomatis infection in women: a multi-parameter evidence synthesis.Crossref | GoogleScholarGoogle Scholar | 27007215PubMed |
[7] World Health Organisation (WHO). Global priority list of antibiotic resistant bacteria to guide research, discovery, and development of new antibiotics. Geneva: WHO; 2015. [cited 2021 February 2]. Available from: http://www.who.int/medicines/publications/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.pdf?ua=1
[8] Best Practice Advocacy Centre (BPAC) New Zealand. Syphilis rates continue to rise. 2019. [cited 2019 May 13]. Available from: https://bpac.org.nz/2019/syphilis.aspx
[9] New Zealand Sexual Health Society. Sexual health check guideline. 2017. [cited 2019 May 17]. Available from: https://www.nzshs.org/docman/guidelines/principles-of-sexual-health-care/148-sexual-health-check-summary/file
[10] The Institute of Environmental Science and Research Ltd. Sexually Transmitted Infections in New Zealand: Annual Surveillance Report 2016. Porirua, New Zealand: ESR; 2019. [cited 2019 August 20]. Available from: https://surv.esr.cri.nz/PDF_surveillance/STISurvRpt/2016/FINAL_2016_STI_AnnualReport.pdf
[11] New Zealand Sexual Health Society. NZSHS STI Management Guidelines for use in primary care. 2017. [cited 2019 November 15]. Available from: http://www.nzshs.org/guidelines.html
[12] Unemo M, Bradshaw CS, Hocking JS, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis. 2017; 17 e235–79.
| Sexually transmitted infections: challenges ahead.Crossref | GoogleScholarGoogle Scholar | 28701272PubMed |
[13] World Health Organization (WHO). Guidelines for the management of sexually transmitted infections. Geneva: World Health Organization; 2003. [cited 2019 November 15]. Available from: http://apps.who.int/iris/bitstream/handle/10665/42782/9241546263_eng.pdf?sequence=1
[14] Rose SB, Garrett SM, Kennedy J, et al. Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoea: a case-note review in New Zealand primary care. J Prim Health Care. 2018; 10 132–39.
| Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoea: a case-note review in New Zealand primary care.Crossref | GoogleScholarGoogle Scholar | 30068468PubMed |
[15] Rose SB, Garrett SM, Stanley J, et al. Retesting and repeat positivity following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoea in New Zealand: a retrospective cohort study. BMC Infect Dis. 2017; 17 526
| Retesting and repeat positivity following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoea in New Zealand: a retrospective cohort study.Crossref | GoogleScholarGoogle Scholar | 28754106PubMed |
[16] Rose SB, Garrett SM, Pullon SRH. Overcoming challenges associated with partner notification following chlamydia and gonorrhoea diagnosis in primary care: a postal survey of doctors and nurses. J Prim Health Care. 2017; 9 136–44.
| Overcoming challenges associated with partner notification following chlamydia and gonorrhoea diagnosis in primary care: a postal survey of doctors and nurses.Crossref | GoogleScholarGoogle Scholar | 29530225PubMed |
[17] Morgan J, Woodhall S. Repeat chlamydia testing across a New Zealand district: 3 years of laboratory data. Sex Transm Infect. 2013; 89 28–31.
| Repeat chlamydia testing across a New Zealand district: 3 years of laboratory data.Crossref | GoogleScholarGoogle Scholar | 22454551PubMed |
[18] Rose SB, Garrett SM, Stanley J, et al. Chlamydia trachomatis and Neisseria gonorrhoeae retesting and reinfection rates in New Zealand Health Care settings: implications for sexually transmitted infection control. Sex Transm Dis. 2020; 47 151–7.
| Chlamydia trachomatis and Neisseria gonorrhoeae retesting and reinfection rates in New Zealand Health Care settings: implications for sexually transmitted infection control.Crossref | GoogleScholarGoogle Scholar | 31880741PubMed |
[19] Best Practice Advocacy Centre New Zealand (BPAC) A “how-to guide” for a sexual health check-up. Best Pract. 2013; 52 . [cited 2020 March 12] http://www.bpac.org.nz/BPJ/2013/April/how-to-guide-sexual-health.aspx
[20] Best Practice Advocacy Centre (BPAC) New Zealand. HIV Pre-Exposure Prophylaxis (PrEP): a how-to guide. 2019. [cited 2019 May 13]. Available from: https://bpac.org.nz/2019/prep.aspx
[21] Best Practice Advocacy Centre (BPAC) New Zealand. Emerging issues in the management of chlamydia and gonorrhoea. 2019. [cited 2019 May 13]. Available from: https://bpac.org.nz/2019/chlamydia-gonorrhoea.aspx
[22] Royal New Zealand College of General Practitioners. RNZCGP College updates: What does Level 2 mean for general practice? 2020. [cited 2020 May 20]. Available from: https://www.rnzcgp.org.nz/Covid19/College_support/College_updates/What_Level_2_looks_like/Covid19/College_support/What_level_2_looks_like.aspx?hkey=393f8ba8-b821-434e-ab84-830a09845b39.
