Chlamydia Knowledge of Australian GPs and Practice Nurses
Chlamydia Knowledge of Australian GPs and Practice Nurses
At the time of the survey 146 PNs and 773 GPs were enrolled in ACCEPt, with 118 (81%) and 556 (72%) returning the survey, respectively. Most of the PN participants (98%) were female, compared with 39% of GP participants. The majority of the participants were aged between 30–59 years (84%); a slightly higher proportion of PNs were aged 45–59 years (51% vs 46%) compared with GPs but the difference was not significant.
The majority of participants (84%) had been qualified for longer than ten years, but PNs had worked in the field of general practice for less time than GPs. PNs were more likely than GPs to have undertaken their primary training in Australia rather than overseas (93% vs 59%) and more likely than GPs to have a special interest in sexual health (47% vs 29%) (see Table 1). At the time of the survey, under half of the PNs (41%) reported involvement in chlamydia testing, whilst most GPs (81%) indicated that they were performing between 1 - 10 chlamydia tests per month.
Less than a third of PNs and GPs could correctly identify both age groups (16–19, and 20–24 years) with the highest rates of chlamydia in women (23% vs 32%), and an even lower proportion correctly identified both age groups (20–24 and 25–29 years) in men (16% vs 17%) with no significant differences between PNs and GPs. The majority of PNs and GPs correctly agreed with the statement that "most chlamydia infections are asymptomatic" in women (88% vs 90%) with a slightly lower proportion agreeing with this statement for men (82% vs 74%). There were no significant differences between the two professions (see Table 1).
Testing Scenarios Close to 80% of PNs compared with about half of the GPs, correctly identified that chlamydia testing should be offered opportunistically in the following asymptomatic clinical scenarios; a 23 year old female presenting for a pap smear (84% vs 57%), a 24 year old pregnant female (85% vs 45%) and a 22 year old Aboriginal or Torres Strait Islander male with a sore throat (79% vs 34%). Similarly, a higher proportion of PNs compared with GPs identified that testing should be conducted in two other opportunistic scenarios which at the time were outside the recommended age group; a 26 year old male presenting for a truck license medical check (78% vs 30%) and a 33 year old female presenting for a pill prescription (83% vs 55%). The difference between professions were significant (p < 0.05 for all).
Nearly all PNs and GPs (around 97%) correctly identified that testing should be offered in young people presenting with STI related symptoms (an 18 year old female with abdominal pain and a 17 year old male with genital warts) and when there is a risk of STIs (a 34 year old male wanting a HIV test) (see Table 2 ).
Specimen Collection Although most PNs and GPs correctly identified the appropriate specimens to be used for asymptomatic and symptomatic patient presentations in women and asymptomatic presentations in heterosexual men, PNs were less likely to report correct responses for all three presentations (see Table 2 ). A much lower proportion of both GPs and PNs could identify the appropriate specimens (urine) for a heterosexual male with urethral discharge (26% vs 13%, p = 0.03) with three-quarters incorrectly indicating a urethral swab should be collected, and the appropriate specimen (urine, and rectal swab) for an asymptomatic man who has sex with men (MSM) (21% vs 12%, p = 0.05) with two-thirds failing to indicate a patient self-collected rectal swab should be collected. The differences between professions were all significant (see Table 2 ).
Retesting PNs were more likely than GPs to correctly identify that a follow up test is recommended after a negative result (74% vs 33%, OR 4.9, 95% CI 2.9, 8.6) and it should be conducted at one year (80% vs 51%, OR 3.3, 95% CI 1.1, 9.3), that a repeat test should be done after a positive chlamydia result (93% vs 87%, OR 2.7, 95% CI 1.1, 6.4), and the appropriate time frame is three months (66% vs 26%, OR 3.8, 95% CI 1.8, 8.11) (p < 0.05 for all).
GP Chlamydia Treatment Practices When asked to choose from a possible list of antibiotics that they usually prescribe for men or non- pregnant women, the majority of GPs (91%) correctly indicated that they usually prescribe azithromycin. In the case of pregnant women with uncomplicated chlamydia infection, under half (41%) would usually prescribe the recommended antibiotic (azithromycin), with 22% choosing erythromycin and 16% amoxicillin.
PN Opinions and Perceived Barriers to Testing A high proportion of PNs agreed that they could conduct chlamydia testing in general practice (90%), they should have a greater role in chlamydia testing (79%) and require additional training or skills to manage testing and treatment of chlamydia (89%). The majority of the PNs wanted more involvement in chlamydia testing in their practices (79%) and to be involved in managing a recall/reminder system for chlamydia testing (75%). Over half indicated they would like involvement in discussing partner notification with patients who test positive for chlamydia (61%).
The most commonly identified barriers to increasing chlamydia testing were patients' lack of chlamydia knowledge (69%) and time constraints during consultations (53%), followed closely by the lack of a formal chlamydia test recall/reminder system (46%) and lack of support for partner notification (46%). A third (33%) identified patient religion/ethnicity and a quarter (26%) lack of support for PNs as barriers, with less than a quarter identifying difficulty talking with clients about sexual health (21%) and cost of testing to client (21%). A very low proportion of nurses thought that the chance of patients getting a false positive result (10%) and concerns about over servicing (4%) were barriers to increasing chlamydia testing (see Table 3 ).
Characteristics of Participants
At the time of the survey 146 PNs and 773 GPs were enrolled in ACCEPt, with 118 (81%) and 556 (72%) returning the survey, respectively. Most of the PN participants (98%) were female, compared with 39% of GP participants. The majority of the participants were aged between 30–59 years (84%); a slightly higher proportion of PNs were aged 45–59 years (51% vs 46%) compared with GPs but the difference was not significant.
The majority of participants (84%) had been qualified for longer than ten years, but PNs had worked in the field of general practice for less time than GPs. PNs were more likely than GPs to have undertaken their primary training in Australia rather than overseas (93% vs 59%) and more likely than GPs to have a special interest in sexual health (47% vs 29%) (see Table 1). At the time of the survey, under half of the PNs (41%) reported involvement in chlamydia testing, whilst most GPs (81%) indicated that they were performing between 1 - 10 chlamydia tests per month.
Chlamydia Knowledge
Less than a third of PNs and GPs could correctly identify both age groups (16–19, and 20–24 years) with the highest rates of chlamydia in women (23% vs 32%), and an even lower proportion correctly identified both age groups (20–24 and 25–29 years) in men (16% vs 17%) with no significant differences between PNs and GPs. The majority of PNs and GPs correctly agreed with the statement that "most chlamydia infections are asymptomatic" in women (88% vs 90%) with a slightly lower proportion agreeing with this statement for men (82% vs 74%). There were no significant differences between the two professions (see Table 1).
Chlamydia Practice
Testing Scenarios Close to 80% of PNs compared with about half of the GPs, correctly identified that chlamydia testing should be offered opportunistically in the following asymptomatic clinical scenarios; a 23 year old female presenting for a pap smear (84% vs 57%), a 24 year old pregnant female (85% vs 45%) and a 22 year old Aboriginal or Torres Strait Islander male with a sore throat (79% vs 34%). Similarly, a higher proportion of PNs compared with GPs identified that testing should be conducted in two other opportunistic scenarios which at the time were outside the recommended age group; a 26 year old male presenting for a truck license medical check (78% vs 30%) and a 33 year old female presenting for a pill prescription (83% vs 55%). The difference between professions were significant (p < 0.05 for all).
Nearly all PNs and GPs (around 97%) correctly identified that testing should be offered in young people presenting with STI related symptoms (an 18 year old female with abdominal pain and a 17 year old male with genital warts) and when there is a risk of STIs (a 34 year old male wanting a HIV test) (see Table 2 ).
Specimen Collection Although most PNs and GPs correctly identified the appropriate specimens to be used for asymptomatic and symptomatic patient presentations in women and asymptomatic presentations in heterosexual men, PNs were less likely to report correct responses for all three presentations (see Table 2 ). A much lower proportion of both GPs and PNs could identify the appropriate specimens (urine) for a heterosexual male with urethral discharge (26% vs 13%, p = 0.03) with three-quarters incorrectly indicating a urethral swab should be collected, and the appropriate specimen (urine, and rectal swab) for an asymptomatic man who has sex with men (MSM) (21% vs 12%, p = 0.05) with two-thirds failing to indicate a patient self-collected rectal swab should be collected. The differences between professions were all significant (see Table 2 ).
Retesting PNs were more likely than GPs to correctly identify that a follow up test is recommended after a negative result (74% vs 33%, OR 4.9, 95% CI 2.9, 8.6) and it should be conducted at one year (80% vs 51%, OR 3.3, 95% CI 1.1, 9.3), that a repeat test should be done after a positive chlamydia result (93% vs 87%, OR 2.7, 95% CI 1.1, 6.4), and the appropriate time frame is three months (66% vs 26%, OR 3.8, 95% CI 1.8, 8.11) (p < 0.05 for all).
GP Chlamydia Treatment Practices When asked to choose from a possible list of antibiotics that they usually prescribe for men or non- pregnant women, the majority of GPs (91%) correctly indicated that they usually prescribe azithromycin. In the case of pregnant women with uncomplicated chlamydia infection, under half (41%) would usually prescribe the recommended antibiotic (azithromycin), with 22% choosing erythromycin and 16% amoxicillin.
PN Opinions and Perceived Barriers to Testing A high proportion of PNs agreed that they could conduct chlamydia testing in general practice (90%), they should have a greater role in chlamydia testing (79%) and require additional training or skills to manage testing and treatment of chlamydia (89%). The majority of the PNs wanted more involvement in chlamydia testing in their practices (79%) and to be involved in managing a recall/reminder system for chlamydia testing (75%). Over half indicated they would like involvement in discussing partner notification with patients who test positive for chlamydia (61%).
The most commonly identified barriers to increasing chlamydia testing were patients' lack of chlamydia knowledge (69%) and time constraints during consultations (53%), followed closely by the lack of a formal chlamydia test recall/reminder system (46%) and lack of support for partner notification (46%). A third (33%) identified patient religion/ethnicity and a quarter (26%) lack of support for PNs as barriers, with less than a quarter identifying difficulty talking with clients about sexual health (21%) and cost of testing to client (21%). A very low proportion of nurses thought that the chance of patients getting a false positive result (10%) and concerns about over servicing (4%) were barriers to increasing chlamydia testing (see Table 3 ).