Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand

Abstract

Health disparities often reflect inequitable access to appropriate health care. This study aimed to establish if cases of genital chlamydia infection were managed equitably by age, gender and ethnicity in a region of New Zealand with high rates of chlamydia infection (858 per 100,000 population). Clinical records of 415 genital chlamydia cases from 19 different health-care sites, including general practice and community settings, were reviewed. Data were analysed by demographic variables. For those treated, men were treated more quickly than women (median 3 days versus 6 days, P < 0.001), but there was no difference by ethnicity. Cases without documented treatment were more likely to be women (8.2% versus 2.1%, P = 0.037) and more likely to be Māori than non-Māori (13.6% versus 4.8%, P = 0.036). Overall, the most notable issue was the lack of effective partner notification across all demographic variables. Ongoing efforts are required to ensure equitable access to timely treatment and to ensure that more effective partner notification strategies are implemented.

Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoeae: a case-note review in New Zealand primary care

“…This research adds to work carried out previously in the Waikato region, 15,16 further emphasising the need for a more systematic approach to Sti case management (and documentation) in primary care. We reviewed only a modest number of cases overall, as our review served as the preliminary data collection phase for a planned pilot study designed to trial new approaches to partner notification and follow up that required participation by only six clinics.…”

“…Our findings are consistent with research conducted in the Waikato region that reviewed 415 chlamydia cases diagnosed across 20 clinical settings in 2008. 15,16 Details related to diagnosis and treatment of the Sti were generally well documented in both studies, but less well with respect to sexual history taking and partner notification. approximately half of case records in both studies had no detail about recent sexual history.…”

“…We adapted an existing audit template to collect data relating to diagnosis, treatment, advice given (including partner notification discussion), follow up, partner notification outcomes and retesting, as documented in electronic patient notes. 15 The form was completed by a clinical member of the research team (in six practices) or by a member of the participating practice team (two practices requested that their own nurses complete the review).…”

“…5 There are recognised provider and patient-related challenges associated with effective partner notification and follow up, [11][12][13][14] and research in New Zealand suggests that this aspect of Sti management is not generally well carried out. 15,16 Before initiating a pilot study to trial new approaches to partner notification management and testing for reinfection (trial number: aCtrN12616000837426), we undertook baseline data collection reviewing the documented management of chlamydia and gonorrhoea cases diagnosed in primary care to determine the extent of partner notification, follow up and testing for reinfection undertaken according to NZSHS guidelines. with one or more positive results during that period were ranked from the highest to lowest count, and 10 of the top 20 were invited to participate in the study (excluding Family Planning and Sexual Health Services).…”

Does a clinical guideline change chlamydia testing? Report from the Waikato Chlamydia Project

“…Importantly, non-Maori were more likely to have clear documentation of receiving any antibiotic treatment. 18 Discussions with audit participants about actual practice highlighted the significant role of practice nurses in testing and treatment. Participants provided helpful feedback as to ways in which their clinical practice improved post-audit and this information was included in the subsequent continuing medical education (CME) sessions.…”