Interventions for increasing chlamydia screening in primary care: a review

Ginige, Samitha; Fairley, Christopher K.; Hocking, Jane S; Bowden, Francis J.; Chen, Marcus Y

doi:10.1186/1471-2458-7-95

Cited by 29 publications

(27 citation statements)

References 13 publications

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“…This clinical finding is in agreement with the syndromic approach protocol for vaginal discharge and cervicitis established by the Brazilian Health Ministry [29]. Emphasizing the relevance of this fact, considering that chlamydial infections are usually asymptomatic and therefore difficult to screen, women without such a marker would be considered to be at high risk of ascending infection, which may lead to severe complications resulting in tubal damage [27]. …”

Section: Discussionsupporting

confidence: 62%

“…These factors may result in a large reservoir of undiagnosed upper genital tract chlamydia infections, which may lead to late development of complications. It has been suggested that silent infections may in fact be the most common cause of tubal infertility [19,24,27]. An interesting observation is that, in the group of 106 women who participated in this study, 4 participants declared that they had episodes of EP.…”

Section: Discussionmentioning

confidence: 71%

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High Prevalence Detection of <i>Chlamydia trachomatis</i> by Polymerase Chain Reaction in Endocervical Samples of Infertile Women Attending University Hospital in Manaus-Amazonas, Brazil

Freitas

Borborema-Santos²,

Neves³

et al. 2011

Gynecol Obstet Invest

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Background: We established for the first time the prevalence of Chlamydia trachomatis infection among infertile women in Manaus Amazonas Brazil using the polymerase chain reaction (PCR) technique. Methods: 106 women were studied at a public university hospital fertility clinic for infertility problems correlated with chlamydia infection. Social-economic and clinical information was obtained before medical examination to obtain samples for the amplification of C. trachomatis DNA plasmid. Results: The prevalence of chlamydial infection among infertile women was 52.8, and 51.8% of the positive participants were older than 30 years of age (p = 0.8697). Of the 56 women positive for C. trachomatis, 31 (55.4%) had never given birth, while 9 (16%) had a pregnancy resulting in fetal death. Our findings also revealed that these patients had a low socio-economic status and high unemployment (p = 0.0274), and a significant association of 5% (p < 0.05) of chlamydial infection with family income. Conclusions: Due to the high prevalence of C. trachomatis, concerns about effects on reproductive health and fertility are undertaken. Therefore, we believe it is extremely necessary to implement large-scale PCR-based screening as part of routine clinical detection programs concerning preventive effects of chlamydial infection among this population.

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Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 71%

High Prevalence Detection of <i>Chlamydia trachomatis</i> by Polymerase Chain Reaction in Endocervical Samples of Infertile Women Attending University Hospital in Manaus-Amazonas, Brazil

Freitas

Borborema-Santos²,

Neves³

et al. 2011

Gynecol Obstet Invest

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“…Twenty-eight reviews [20, 21, 29, 32–56] ( n = 509 studies) evaluated educational interventions. Evidence from moderate- to high-quality reviews demonstrated that education to improve knowledge and skills [37–42, 48, 49, 51–56], continuing medical education [20, 21, 29, 34, 43], and academic detailing [32] were found to be effective in professional development to increase knowledge, optimize prescriptions, screening rate, and improve patient outcomes [20, 29, 32–36, 41, 44, 45, 50, 54].…”

Section: Resultsmentioning

confidence: 99%

“…Evidence from moderate- to high-quality reviews demonstrated that education to improve knowledge and skills [37–42, 48, 49, 51–56], continuing medical education [20, 21, 29, 34, 43], and academic detailing [32] were found to be effective in professional development to increase knowledge, optimize prescriptions, screening rate, and improve patient outcomes [20, 29, 32–36, 41, 44, 45, 50, 54]. Certain education interventions were evaluated as components of multifaceted education interventions, including interactive educational methods, reminder systems, audit and feedback, academic detailing, computer-based learning, lecture, as well as pamphlet in several reviews [29, 33, 36, 43, 44, 49]; which reported improvement in implementing guidelines into general practice [29], improved antibiotic prescribing [33], improved detection of cancer, dementia, and skin lesions [36, 44, 49].…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2017

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BackgroundThere is a plethora of interventions and policies aimed at changing practice habits of primary healthcare professionals, but it is unclear which are the most appropriate, sustainable, and effective. We aimed to evaluate the evidence on behavior change interventions and policies directed at healthcare professionals working in primary healthcare centers.MethodsStudy design: overview of reviews.Data source: MEDLINE (Ovid), Embase (Ovid), The Cochrane Library (Wiley), CINAHL (EbscoHost), and grey literature (January 2005 to July 2015).Study selection: two reviewers independently, and in duplicate, identified systematic reviews, overviews of reviews, scoping reviews, rapid reviews, and relevant health technology reports published in full-text in the English language.Data extraction and synthesis: two reviewers extracted data pertaining to the types of reviews, study designs, number of studies, demographics of the professionals enrolled, interventions, outcomes, and authors’ conclusions for the included studies. We evaluated the methodological quality of the included studies using the AMSTAR scale. For the comparative evaluation, we classified interventions according to the behavior change wheel (Michie et al.).ResultsOf 2771 citations retrieved, we included 138 reviews representing 3502 individual studies. The majority of systematic reviews (91%) investigated behavior and practice changes among family physicians. Interactive and multifaceted continuous medical education programs, training with audit and feedback, and clinical decision support systems were found to be beneficial in improving knowledge, optimizing screening rate and prescriptions, enhancing patient outcomes, and reducing adverse events. Collaborative team-based policies involving primarily family physicians, nurses, and pharmacists were found to be most effective. Available evidence on environmental restructuring and modeling was found to be effective in improving collaboration and adherence to treatment guidelines. Limited evidence on nurse-led care approaches were found to be as effective as general practitioners in patient satisfaction in settings like asthma, cardiovascular, and diabetes clinics, although this needs further evaluation. Evidence does not support the use of financial incentives to family physicians, especially for long-term behavior change.ConclusionsBehavior change interventions including education, training, and enablement in the context of collaborative team-based approaches are effective to change practice of primary healthcare professionals. Environmental restructuring approaches including nurse-led care and modeling need further evaluation. Financial incentives to family physicians do not influence long-term practice change.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0538-8) contains supplementary material, which is available to authorized users.

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“…There are several interventions that increase overall screening rates, using provider education, prompts, and incentives, as well as system-level changes. [21][22][23][24][25][26][27] Although the majority of those studies showed improved chlamydia screening rates for intervention groups, overall screening rates remained fairly low. Few if any studies have addressed differences in testing rates.…”

Section: Discussionmentioning

confidence: 99%

Chlamydia Screening Among Young Women: Individual- and Provider-Level Differences in Testing

et al. 2011

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WHAT'S KNOWN ON THIS SUBJECT:Chlamydia testing among adolescents and young women without symptoms is recommended by the US Preventive Services Task Force, but only approximately one-half of eligible young women presenting for health care are screened appropriately. WHAT THIS STUDY ADDS:Our work indicates that providers screen young women for chlamydia differentially according to patient age, race/ethnicity, insurance status, and sexual health history. Biases in chlamydia screening may contribute to higher reported rates of chlamydia among minority and poor young women.abstract OBJECTIVE: We assessed differences in chlamydia screening rates according to race/ethnicity, insurance status, age, and previous sexually transmitted infection (STI) or pregnancy. METHODS:A retrospective cohort study was performed using electronic medical record and billing data for women 14 to 25 years of age in 2002-2007, assessing differences in the odds of a chlamydia test being performed at that visit. : 5.13-9.15]) insurance had increased odds of testing, compared with women with private insurance. After first STI diagnosis, differences according to race/ethnicity persisted but were smaller; after first pregnancy, differences persisted. RESULTS: CONCLUSIONS:Despite recommendations to screen all sexually active young women for chlamydia, providers screened women differently according to age, race/ethnicity, and insurance status, although differences were reduced after first STI or pregnancy. Pediatrics 2011;127:e336-e344 AUTHORS:

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Interventions for increasing chlamydia screening in primary care: a review

Abstract: Background: Despite guidelines recommending opportunistic chlamydia screening of younger women, screening rates in some countries remain low. Our aim was to review the evidence for specific interventions aimed at increasing chlamydia screening rates in primary care.

Cited by 29 publications

References 13 publications

High Prevalence Detection of <i>Chlamydia trachomatis</i> by Polymerase Chain Reaction in Endocervical Samples of Infertile Women Attending University Hospital in Manaus-Amazonas, Brazil

High Prevalence Detection of <i>Chlamydia trachomatis</i> by Polymerase Chain Reaction in Endocervical Samples of Infertile Women Attending University Hospital in Manaus-Amazonas, Brazil

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

Chlamydia Screening Among Young Women: Individual- and Provider-Level Differences in Testing

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