Usefulness of primary care electronic networks to assess the incidence of chlamydia, diagnosed by general practitioners

Suijkerbuijk, Anita; Broek, Ingrid V F van den; Brouwer, Henk J.; Vanrolleghem, Ann M.; Joosten, Johanna H. K.; Verheij, Robert; Sande, Marianne A. B. van der; Kretzschmar, Mirjam

doi:10.1186/1471-2296-12-72

Cited by 9 publications

(10 citation statements)

References 18 publications

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“…In recent years, an increasing trend was observed in the numbers of consultations for STI testing at STI clinics, however positivity rates remained fairly stable [19]. A substantial fraction of cases are diagnosed and treated by GPs and are not reported to national surveillance [20]. In 2001, Chlamydia prevalence was measured in the general population in a sample of 3458 men and 4925 women [1].…”

Section: Methodsmentioning

confidence: 99%

Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates

Schmid¹,

Over

Broek³

et al. 2013

PLoS ONE

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BackgroundA large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008–2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16–29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future.Methods and FindingsWe used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run.ConclusionsDecreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.

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Section: Methodsmentioning

confidence: 99%

Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates

Schmid¹,

Over

Broek³

et al. 2013

PLoS ONE

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“…Insight into STI consultations in general practice is limited to reporting rates from sentinel surveillance based on electronic medical registration by International Classification of Primary Care (ICPC) codes. These data lack information on diagnostic tests performed and patient characteristics of those tested 1 2. Since an estimated 70% of all STI/HIV consultations take place at the general practice in the Netherlands,1 3 more detailed data on STI consultations in primary care are required to gain a more comprehensive overview of the STI epidemiology and testing behaviour in the country, necessary for surveillance and control.…”

Section: Introductionmentioning

confidence: 99%

Consultations for sexually transmitted infections in the general practice in the Netherlands: an opportunity to improve STI/HIV testing

et al. 2013

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ObjectivesIn the Netherlands, sexually transmitted infection (STI) care is provided by general practitioners (GPs) as well as by specialised STI centres. Consultations at the STI centres are monitored extensively, but data from the general practice are limited. This study aimed to examine STI consultations in the general practice.DesignProspective observational patient survey.SettingGeneral practices within the nationally representative Dutch Sentinel GP network (n=125 000 patient population), 2008–2011.Outcome measuresGPs were asked to fill out a questionnaire at each STI consultation addressing demographics, sexual behaviour and laboratory test results. Patient population, testing practices and test positivity are reported.ParticipantsPatients attending a consultation concerning an STI/HIV-related issue.ResultsOverall, 1 in 250 patients/year consulted their GP for STI/HIV-related problems. Consultations were concentrated among young heterosexuals of Dutch origin. Laboratory testing was requested for 83.3% of consultations. Overall consult positivity was 33.4%, highest for chlamydia (14.7%), condylomata (8.7%) and herpes (6.4%). 32 of 706 positive patients (4.5%) were diagnosed with multiple infections. Main high-risk groups were patients who were <25 years old (for chlamydia), >25 years old (syphilis), men who have sex with men (MSM; for gonorrhoea/syphilis/HIV) or having symptoms (for any STI). Adherence to guideline-recommendations to test for multiple STI among high-risk groups varied from 15% to 75%.ConclusionsThis study found that characteristics of patients who consulted a GP for STIs were comparable to those of patients attending STI centres regarding age and ethnicity; however, consultations of high-risk groups like MSM and (clients of) commercial sex workers were reported less by the general practice. Where the STI centres routinely test all patients for chlamydia/syphilis/HIV/gonorrhoea, GPs tested more selectively, even more restricted than advised by GP guidelines. Test positivity was, therefore, higher in general practice, although it is unknown how many STIs are missed (particularly among high-risk groups). Opportunities for a more proactive role in STI/HIV testing at general practices in line with current guidelines should be explored.

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“…For their “Comparison of STI-Related Consultations among Ethnic Groups in the Netherlands,” Woestenberg and colleagues [ 27 ] used the application EPICON “that groups consultations with similar ICPC-codes occurring less than two months apart” ([ 27 , p. 2]; [ 28 ]). Following the example of Suijkerbuijk and colleagues on Chlamydia trachomatis infections diagnosed by GPs in the Netherlands [ 29 , p. 3], we counted a second episode with the same diagnosis for the same patient as a new case only after an interval of at least two months after the beginning date of the first diagnosis. We defined the two month-interval as 62 days.…”

Section: Methodsmentioning

confidence: 99%

Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009–2013: A Registry-Based Retrospective Cohort Study

Schweikardt

Goderis

Elli

et al. 2017

Journal of Sexually Transmitted Diseases

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Background General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. Objectives This study investigates to which extent contemporary gonorrhoea treatment guidelines were followed. Methods A retrospective cohort study (2009–2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc. Results Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Conclusion Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013.

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Usefulness of primary care electronic networks to assess the incidence of chlamydia, diagnosed by general practitioners

Cited by 9 publications

References 18 publications

Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates

Effects of Population Based Screening for Chlamydia Infections in The Netherlands Limited by Declining Participation Rates

Consultations for sexually transmitted infections in the general practice in the Netherlands: an opportunity to improve STI/HIV testing

Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009–2013: A Registry-Based Retrospective Cohort Study

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