Better than nothing? Patient-delivered partner therapy and partner notification for chlamydia: the views of Australian general practitioners

Abstract

BackgroundGenital chlamydia is the most commonly notified sexually transmissible infection (STI) in Australia and worldwide and can have serious reproductive health outcomes. Partner notification, testing and treatment are important facets of chlamydia control. Traditional methods of partner notification are not reaching enough partners to effectively control transmission of chlamydia. Patient-delivered partner therapy (PDPT) has been shown to improve the treatment of sexual partners. In Australia, General Practitioners (GPs) are responsible for the bulk of chlamydia testing, diagnosis, treatment and follow up. This study aimed to determine the views and practices of Australian general practitioners (GPs) in relation to partner notification and PDPT for chlamydia and explored GPs' perceptions of their patients' barriers to notifying partners of a chlamydia diagnosis.MethodsIn-depth, semi-structured telephone interviews were conducted with 40 general practitioners (GPs) from rural, regional and urban Australia from November 2006 to March 2007. Topics covered: GPs' current practice and views about partner notification, perceived barriers and useful supports, previous use of and views regarding PDPT.Transcripts were imported into NVivo7 and subjected to thematic analysis. Data saturation was reached after 32 interviews had been completed.ResultsPerceived barriers to patients telling partners (patient referral) included: stigma; age and cultural background; casual or long-term relationship, ongoing relationship or not. Barriers to GPs undertaking partner notification (provider referral) included: lack of time and staff; lack of contact details; uncertainty about the legality of contacting partners and whether this constitutes breach of patient confidentiality; and feeling both personally uncomfortable and inadequately trained to contact someone who is not their patient. GPs were divided on the use of PDPT - many felt concerned that it is not best clinical practice but many also felt that it is better than nothing.GPs identified the following factors which they considered would facilitate partner notification: clear clinical guidelines; a legal framework around partner notification; a formal chlamydia screening program; financial incentives; education and practical support for health professionals, and raising awareness of chlamydia in the community, in particular amongst young people.ConclusionsGPs reported some partners do not seek medical treatment even after they are notified of being a sexual contact of a patient with chlamydia. More routine use of PDPT may help address this issue however GPs in this study had negative attitudes to the use of PDPT. Appropriate guidelines and legislation may make the use of PDPT more acceptable to Australian GPs.

Healthcare providers’ perspectives on expedited partner therapy for chlamydia: a qualitative study: Table 1

“…Our findings around barriers and facilitators to EPT were similar to the findings of studies conducted in the UK and Australia. A qualitative study conducted with general practitioners about their views on EPT and partner notification to treat chlamydia in Australia, a country that has no specific legislation about EPT, found that providers had concerns about treating a patient without evaluating their medical history and asserted that clarity around the legality of EPT would facilitate its use 24. A survey in the UK found that 22% of providers had used EPT, around one-third were opposed to the practice, providers felt that speaking on the phone with the partner was important, and the largest barrier to its use was the legality of EPT 25…”

Missed opportunities—low levels of chlamydia retesting at Australian general practices, 2008–2009

“…Patient-Delivered Partner Therapy (PDPT) may be a viable option to increase the proportion of partners being notified and treated12 and decrease likelihood of patient reinfection compared with standard partner notification 11 35. PDPT is already used by some Australian GPs, particularly when it is assessed unlikely that the partner will attend,36 but many GPs still express concerns about its use 37. Clinical guidelines on the appropriate use of PDPT, education on its safety and effectiveness and supportive legislation would likely increase the acceptance of PDPT by providers and patients alike 37…”

Partner notification and partner treatment for chlamydia: attitude and practice of general practitioners in the Netherlands; a landscape analysis

“…Successful treatment of current partners is most important for preventing reinfection of index cases and reducing further transmission of chlamydia at the population level. On the other hand, also for casual partners, or when it is likely that partners will not seek treatment and are at high risk of infection, PIPT is a good last option or ‘better than nothing’ [31]. Modelling studies by Althaus [32, 33] showed that PN for partners up to 18 months back would identify 10% infections in notified partners.…”

“…[30, 31] GPs stated in the questionnaire that PIPT reduces the opportunity for the partner to see a professional and get further STI counselling and advice. [34] Current legislation requires direct contact with partners.…”