Do Australian general practitioners believe practice nurses can take a role in chlamydia testing? A qualitative study of attitudes and opinions

Abstract

BackgroundChlamydia notifications continue to rise in young people in many countries and regular chlamydia testing is an important prevention strategy. Although there have been initiatives to increase testing in primary care, none have specifically investigated the role of practice nurses (PNs) in maximising testing rates. PNs have previously expressed a willingness to be involved, but noted lack of support from general practitioners (GPs) as a barrier. We sought GPs’ attitudes and opinions on PNs taking an expanded role in chlamydia testing and partner notification.MethodsIn the context of a cluster randomised trial in mostly rural towns in 4 Australian states, semi structured interviews were conducted with 44 GPs between March 2011 and July 2012. Data relating to PN involvement in chlamydia testing were thematically analysed using a conventional content analysis approach.ResultsThe majority of GPs interviewed felt that a role for PNs in chlamydia testing was appropriate. GPs felt that PNs had more time for patient education and advice, that patients would find PNs easier to talk to and less intimidating than GPs, and that GPs themselves could benefit through a reduction in their workload. Although GPs felt that PNs could be utilised more effectively for preventative health activities such as chlamydia testing, many raised concerns about how these activities would be renumerated whilst some felt that existing workload pressures for PNs could make it difficult for them to expand their role. Whilst some rural GPs recognised that PNs might be well placed to conduct partner notification, they also recognised that issues of patient privacy and confidentiality related to living in a “small town” was also a concern.ConclusionThis is the first qualitative study to explore GPs’ views around an increased role for PNs in chlamydia testing. Despite the concerns raised by PNs, these findings suggest that GPs support the concept and recognise that PNs are suited to the role. However issues raised, such as funding and remuneration may act as barriers that will need to be addressed before PNs are supported to make a contribution to increasing chlamydia testing rates in general practice.

Practice nurse chlamydia testing in Australian general practice: a qualitative study of benefits, barriers and facilitators

“…It is also interesting to note there may be some disparity between PNs’ perception of GP attitudes and the actual attitudes of GPs. In a series of qualitative interviews with 44 GPs undertaken as part of ACCEPt, the vast majority supported the concept of PN chlamydia testing, identifying similar benefits to their involvement as were raised by the PNs in this study [ 32 ].…”

Exploring why a complex intervention piloted in general practices did not result in an increase in chlamydia screening and diagnosis: a qualitative evaluation using the fidelity of implementation model

“…Furthermore, as the 3Cs and HIV is a complex intervention with multifaceted components and outcomes, a specific action plan detailing staff’s roles and responsibilities to implement the intervention should have been agreed at the end of the training session and re-visited at practice meetings [44, 45]. …”

“…Additionally, more specificity was necessary in regards to where the posters should have been displayed, as the educational workshops suggested that posters displayed in consultation rooms could be used as a prompt or conversation starter, but this was not always adhered to. Furthermore, as the 3Cs and HIV is a complex intervention with multifaceted components and outcomes, a specific action plan detailing staff’s roles and responsibilities to implement the intervention should have been agreed at the end of the training session and re-visited at practice meetings [ 44 , 45 ].…”

Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing

“…Australian primary care nurses indicated that the provision of training, streamlining chlamydia testing and simplification of pathology ordering processes would also facilitate nurses’ chlamydia testing. 19 As other work has found little significant difference in GP care provision in our four countries involved, 4 the intervention should be easily transferable. In Sweden and England, sexual health is established in the GP medical training curriculum, 4 which will facilitate implementation, whereas in France, sexual health training was not mandatory and in Estonia, it was extremely limited.…”

“…It is interesting that the barriers to chlamydia testing in general practice we identified in this study are similar to those identified across primary care settings: in England 17 18 and Australia. 19 20 Continued barriers to sexual health provision in general practice indicate that behaviourally based interventions are needed to allow chlamydia testing to become embedded in routine practice. GP staff in the previous CIRT study who successfully increased their practice’s chlamydia screening 21 had implemented many of the suggestions made by staff in the other countries of this study, including: computer prompts that helped staff remember to make the offer, having a designated lead and feedback about the general practice’s testing rates.…”