1
|
McCormack H, Wand H, Newman CE, Bourne C, Kennedy C, Guy R. Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation. JMIR Med Inform 2023; 11:e51387. [PMID: 38032729 PMCID: PMC10722379 DOI: 10.2196/51387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. OBJECTIVE We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. METHODS We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. RESULTS Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. CONCLUSIONS This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.
Collapse
Affiliation(s)
- Heather McCormack
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
| | - Handan Wand
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Christy E Newman
- Centre for Social Research in Health, University of New South Wales, Kensington, Australia
| | - Christopher Bourne
- Kirby Institute, University of New South Wales, Kensington, Australia
- Centre for Population Health, New South Wales Ministry of Health, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | | | - Rebecca Guy
- Kirby Institute, University of New South Wales, Kensington, Australia
| |
Collapse
|
2
|
Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
Collapse
Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
| | | |
Collapse
|
3
|
Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review. Implement Sci 2018; 13:130. [PMID: 30348165 PMCID: PMC6196559 DOI: 10.1186/s13012-018-0821-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model. Methods Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Four hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma). Conclusions This systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed. Trial registration PROSPERO CRD42016041786 Electronic supplementary material The online version of this article (10.1186/s13012-018-0821-y) contains supplementary material, which is available to authorized users.
Collapse
|
4
|
Yeung A, Hocking J, Guy R, Fairley CK, Smith K, Vaisey A, Donovan B, Imrie J, Gunn J, Temple-Smith M. 'It Opened My Eyes'-examining the impact of a multifaceted chlamydia testing intervention on general practitioners using Normalization Process Theory. Fam Pract 2018; 35:626-632. [PMID: 29608672 DOI: 10.1093/fampra/cmy011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chlamydia is the most common notifiable sexually transmissible infection in Australia. Left untreated, it can develop into pelvic inflammatory disease and infertility. The majority of notifications come from general practice and it is ideally situated to test young Australians. OBJECTIVES The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) was a multifaceted intervention that aimed to reduce chlamydia prevalence by increasing testing in 16- to 29-year-olds attending general practice. GPs were interviewed to describe the effectiveness of the ACCEPt intervention in integrating chlamydia testing into routine practice using Normalization Process Theory (NPT). METHODS GPs were purposively selected based on age, gender, geographic location and size of practice at baseline and midpoint. Interview data were analysed regarding the intervention components and results were interpreted using NPT. RESULTS A total of 44 GPs at baseline and 24 at midpoint were interviewed. Most GPs reported offering a test based on age at midpoint versus offering a test based on symptoms or patient request at baseline. Quarterly feedback was the most significant ACCEPt component for facilitating a chlamydia test. CONCLUSIONS The ACCEPt intervention has been able to moderately normalize chlamydia testing among GPs, although the components had varying levels of effectiveness. NPT can demonstrate the effective implementation of an intervention in general practice and has been valuable in understanding which components are essential and which components can be improved upon.
Collapse
Affiliation(s)
- Anna Yeung
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Jane Hocking
- Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rebecca Guy
- Sexual Health Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Kirsty Smith
- Sexual Health Program, Kirby Institute, University of New South Wales, Sydney, Australia
| | - Alaina Vaisey
- Sexual Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Basil Donovan
- Sexual Health Program, Kirby Institute, University of New South Wales, Sydney, Australia.,Sydney Sexual Health Centre, Sydney, Australia
| | - John Imrie
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Durban, South Africa
| | - Jane Gunn
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
| | - Meredith Temple-Smith
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Melbourne, Australia
| | | |
Collapse
|
5
|
McNulty C, Ricketts EJ, Fredlund H, Uusküla A, Town K, Rugman C, Tisler-Sala A, Mani A, Dunais B, Folkard K, Allison R, Touboul P. Qualitative interviews with healthcare staff in four European countries to inform adaptation of an intervention to increase chlamydia testing. BMJ Open 2017; 7:e017528. [PMID: 28951413 PMCID: PMC5623510 DOI: 10.1136/bmjopen-2017-017528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the needs of primary healthcare general practice (GP) staff, stakeholders and trainers to inform the adaptation of a locally successful complex intervention (Chlamydia Intervention Randomised Trial (CIRT)) aimed at increasing chlamydia testing within primary healthcare within South West England to three EU countries (Estonia, France and Sweden) and throughout England. DESIGN Qualitative interviews. SETTING European primary healthcare in England, France, Sweden and Estonia with a range of chlamydia screening provision in 2013. PARTICIPANTS 45 GP staff, 13 trainers and 18 stakeholders. INTERVIEWS The iterative interview schedule explored participants' personal attitudes, subjective norms and perceived behavioural controls around provision of chlamydia testing, sexual health services and training in general practice. Researchers used a common thematic analysis. RESULTS Findings were similar across all countries. Most participants agreed that chlamydia testing and sexual health services should be offered in general practice. There was no culture of GP staff routinely offering opportunistic chlamydia testing or sexual health advice, and due to other priorities, participants reported this would be challenging. All participants indicated that the CIRT workshop covering chlamydia testing and sexual health would be useful if practice based, included all practice staff and action planning, and was adequately resourced. Participants suggested minor adaptations to CIRT to suit their country's health services. CONCLUSIONS A common complex intervention can be adapted for use across Europe, despite varied sexual health provision. The intervention (ChlamydiA Testing Training in Europe (CATTE)) should comprise: a staff workshop covering sexual health and chlamydia testing rates and procedures, action planning and patient materials and staff reminders via computer prompts, emails or newsletters, with testing feedback through practice champions. CATTE materials are available at: www.STItraining.eu.
Collapse
Affiliation(s)
- Cliodna McNulty
- Department of Microbiology, Public Health, Primary Care Unit, Gloucestershire Royal Hospital, Derriford Hospital, Plymouth, UK
| | | | - Hans Fredlund
- Department of Laboratory Medicine, County Medical Officer, Orebro University, Orebro, Sweden
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Katy Town
- Department of HIV and STI, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - Claire Rugman
- Department of Microbiology, Public Health, Primary Care Unit, Gloucestershire Royal Hospital, Derriford Hospital, Plymouth, UK
| | - Anna Tisler-Sala
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Alix Mani
- Departement of de Sante Publique, Nice University Hospital, Nice, France
| | - Brigitte Dunais
- Departement of de Sante Publique, Nice University Hospital, Nice, France
| | - Kate Folkard
- Department of HIV and STI, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - Rosalie Allison
- Department of Microbiology, Public Health, Primary Care Unit, Gloucestershire Royal Hospital, Derriford Hospital, Plymouth, UK
| | - Pia Touboul
- Department of General Practice, Nice Sophia Antipolis University, Nice, France
| |
Collapse
|
6
|
Allison R, Lecky DM, Town K, Rugman C, Ricketts EJ, Ockendon-Powell N, Folkard KA, Dunbar JK, McNulty CAM. 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. BMC FAMILY PRACTICE 2017; 18:43. [PMID: 28327096 PMCID: PMC5361828 DOI: 10.1186/s12875-017-0618-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/07/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chlamydia trachomatis (chlamydia) is the most commonly diagnosed sexually transmitted infection (STI) in England; approximately 70% of diagnoses are in sexually active young adults aged under 25. To facilitate opportunistic chlamydia screening in general practice, a complex intervention, based on a previously successful Chlamydia Intervention Randomised Trial (CIRT), was piloted in England. The modified intervention (3Cs and HIV) aimed to encourage general practice staff to routinely offer chlamydia testing to all 15-24 year olds regardless of the type of consultation. However, when the 3Cs (chlamydia screening, signposting to contraceptive services, free condoms) and HIV was offered to a large number of general practitioner (GP) surgeries across England, chlamydia screening was not significantly increased. This qualitative evaluation addresses the following aims: a) Explore why the modified intervention did not increase screening across all general practices. b) Suggest recommendations for future intervention implementation. METHODS Phone interviews were carried out with 26 practice staff, at least 5 months after their initial educational workshop, exploring their opinions on the workshop and intervention implementation in the real world setting. Interview transcripts were thematically analysed and further examined using the fidelity of implementation model. RESULTS Participants who attended had a positive attitude towards the workshops, but attendee numbers were low. Often, the intervention content, as detailed in the educational workshops, was not adhered to: practice staff were unaware of any on-going trainer support; computer prompts were only added to the female contraception template; patients were not encouraged to complete the test immediately; complete chlamydia kits were not always readily available to the clinicians; and videos and posters were not utilised. Staff reported that financial incentives, themselves, were not a motivator; competing priorities and time were identified as major barriers. CONCLUSION Not adhering to the exact intervention model may explain the lack of significant increases in chlamydia screening. To increase fidelity of implementation outside of Randomised Controlled Trial (RCT) conditions, and consequently, improve likelihood of increased screening, future public health interventions in general practices need to have: more specific action planning within the educational workshop; computer prompts added to systems and used; all staff attending the workshop; and on-going practice staff support with feedback of progress on screening and diagnosis rates fed back to all staff.
Collapse
Affiliation(s)
- R Allison
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK.
| | - D M Lecky
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| | - K Town
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C Rugman
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, GL1 3NN, UK
| | - E J Ricketts
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Derriford Hospital, Derriford Road, Plymouth, UK
| | - N Ockendon-Powell
- Formerly Public Health England, Primary Care Unit, Microbiology Dept., Gloucester, now Biotechnology and Biological Sciences Research Council (BBSRC), Polaris House, North Star Avenue, Swindon, UK
| | - K A Folkard
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - J K Dunbar
- HIV/STI Department, Centre for Infectious Disease Control and Surveillance, Public Health England, London, UK
| | - C A M McNulty
- Primary Care Unit, National Infection Service, Public Health England, Microbiology Dept, Gloucestershire Royal Hospital, Great Western Road, Gloucester, GL1 3NN, UK
| |
Collapse
|
7
|
Lorch R, Hocking J, Guy R, Vaisey A, Wood A, Lewis D, Temple-Smith M. Practice nurse chlamydia testing in Australian general practice: a qualitative study of benefits, barriers and facilitators. BMC FAMILY PRACTICE 2015; 16:36. [PMID: 25880077 PMCID: PMC4371842 DOI: 10.1186/s12875-015-0251-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/27/2015] [Indexed: 11/17/2022]
Abstract
Background Chlamydia infection is a significant public health issue for young people; however, testing rates in Australian general practice are low. Practice nurses (PNs) could have an important role in contributing to increasing chlamydia testing rates. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt), a large cluster randomised control trial of annual testing for 16 to 29 year olds in general practice, is the first to investigate the role of PNs in maximising testing rates. In order to assess the scope for PN involvement, we aimed to explore PN’s views in relation to involvement in chlamydia testing in general practice. Methods Semi structured interviews were conducted between June 2011 and April 2012 with a purposive sample of 23 PNs participating in ACCEPt. Interview data was thematically analysed using a conventional content analysis approach. Results The participants in our study supported an increased role for PNs in chlamydia testing and identified a number of patient benefits from this involvement, such as an improved service with greater access to testing and patients feeling more comfortable engaging with a nurse rather than a doctor. An alleviation of doctors’ workloads and expansion of the nurse’s role were also identified as benefits at a clinic level. Time and workload constraints were commonly considered barriers to chlamydia testing, along with concerns around privacy in the “small town” rural settings of the general practices. Some felt negative GP attitudes as well as issues with funding for PNs’ work could also be barriers. The provision of training and education, streamlining chlamydia testing pathways in clinics and changes to pathology ordering processes would facilitate nurse involvement in chlamydia testing. Conclusion This study suggests that PNs could take a role in increasing chlamydia testing in general practice and that their involvement may result in possible benefits for patients, doctors, PNs and the community. Strategies to overcome identified barriers and facilitate their involvement must be further explored.
Collapse
Affiliation(s)
- Rebecca Lorch
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Jane Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Rebecca Guy
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
| | - Alaina Vaisey
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Anna Wood
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Dyani Lewis
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | | | | |
Collapse
|