Efficacy of interventions to increase the uptake of chlamydia screening in primary care: a systematic review

Abstract

BackgroundAs most genital chlamydia infections are asymptomatic, screening is the main way to detect and cases for treatment. We undertook a systematic review of studies assessing the efficacy of interventions for increasing the uptake of chlamydia screening in primary care.MethodsWe reviewed studies which compared chlamydia screening in the presence and the absence of an intervention. The primary endpoints were screening rate or total tests.ResultsWe identified 16 intervention strategies; 11 were randomised controlled trials and five observational studies, 10 targeted females only, five both males and females, and one males only. Of the 15 interventions among females, six were associated with significant increases in screening rates at the 0.05 level including a multifaceted quality improvement program that involved provision of a urine jar to patients at registration (44% in intervention clinics vs. 16% in the control clinic); linking screening to routine Pap smears (6.9% vs. 4.5%), computer alerts for doctors (12.2% vs. 10.6%); education workshops for clinic staff; internet-based continuing medical education (15.5% vs. 12.4%); and free sexual health consultations (16.8% vs. 13.2%). Of the six interventions targeting males, two found significant increases including the multifaceted quality improvement program in which urine jars were provided to patients at registration (45% vs. 15%); and the offering by doctors of a test to all presenting young male clients, prior to consultation (29 vs. 4%).ConclusionsInterventions that promoted the universal offer of a chlamydia test in young people had the greatest impact on increasing screening in primary care.

Behavior change interventions and policies influencing primary healthcare professionals’ practice—an overview of reviews

“…Interventions in pharmacy services reduced suboptimal prescribing [117, 127, 133], and educational interventions improved primary healthcare providers’ identification, assessment, prevention and/or management of obesity in children and adolescents to achieve weight loss [121]. No review focused exclusively on audit and feedback, but multifaceted audit/feedback, reminders, educational outreach visits, and patient-mediated interventions [31, 116, 118, 119] were found to be effective in influencing health professionals’ prescribing practice. Financial incentives combined with educational interventions and audit/feedback have been found to be effective in increasing the practice of generic prescribing [124].…”

Increased Sexually Transmitted Disease Testing Among Sexually Active Persons Receiving Medical Care for Human Immunodeficiency Virus Infection in the United States, 2009–2013

“…Examples of effective tools include electronic alerts for doctors; syphilis serology included with blood tests performed as part of HIV monitoring, educational workshops for clinic staff; internet-based continuing medical education; free sexual health consultations for patients; biannual STD testing, coupled with brief risk-reduction counseling; and provision of a urine specimen cup at the time of patient registration. [33–35] These strategies could be used to increase routine STD screening.…”

Increasing chlamydia screening tests in general practice: a modified Zelen prospective Cluster Randomised Controlled Trial evaluating a complex intervention based on the Theory of Planned Behaviour

“…A systematic review has shown that a multifaceted workshop approach addressing barriers to screening is more effective than single-component interventions 19. Several studies have demonstrated that the long-term support is pivotal to increase testing by maintaining the importance of chlamydia testing (addressing personal attitudes) and for it to become normal practice (a subjective norm).…”