Missed opportunities—low levels of chlamydia retesting at Australian general practices, 2008–2009
- Anna L Bowring1,
- Maelenn Gouillou1,
- Rebecca Guy2,
- Fabian Y S Kong1,
- Jane Hocking3,
- Marie Pirotta4,
- Clare Heal5,
- Tom Brett6,
- Basil Donovan2,
- Margaret Hellard1,7,8 on behalf of the ACCESS Collaboration
- 1Centre for Population Health, Burnet Institute, Melbourne, Victoria, Australia
- 2The Kirby Institute, University of New South Wales, New South Wales, Australia
- 3Centre for Women's Health, Gender and Society, University of Melbourne, Carlton, Victoria, Australia
- 4Department of General Practice, University of Melbourne, Carlton, Victoria, Australia
- 5James Cook University, School of Medicine and Dentistry, Mackay Base Hospital, Mackay, Queensland, Australia
- 6General Practice and Primary Health Care Research, School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- 7Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- 8The Nossal Institute for Global Health, University of Melbourne, Carlton, Victoria, Australia
- Correspondence to Anna L Bowring, Centre for Population Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria 3004, Australia (GPO Box 2284, Melbourne, Victoria 3001, Australia);
Contributors The following co-authors have contributed to the work: ALB in data analysis, manuscript preparation and manuscript review; MG in data analysis; RG in manuscript conception, manuscript preparation and manuscript review; FYSK, JH, MP, CH and TB in manuscript review; BD in surveillance system design and manuscript review and MEH in surveillance system design, manuscript preparation and manuscript review.
- Accepted 12 February 2012
- Published Online First 10 March 2012
Objective Chlamydia reinfection is common and increases the risk of reproductive complications. Guidelines for Australian general practitioners recommend retesting 3–12 months after a positive result but not before 6 weeks. The authors describe retesting rates among 16–29-year-old patients diagnosed as having chlamydia at 25 general practice clinics participating in the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance system.
Methods The authors calculated annual testing and positivity rates for 16–29-year-olds attending in 2008–2009, re-attendance and retesting rates within <6 weeks, 1.5–4 months and 1.5–12 months of a positive test in 2008–2009 and positivity at retest (where results were available).
Results There were 50 408 individuals (60.4% women) who attended in 2008–2009. Annually, 7.4% and 7.3% were tested for chlamydia, of whom 9.1% and 8.0% tested positive, respectively. Within 1.5–4 months of a positive test, 24.6% re-attended and were retested (19% tested positive), 31.6% re-attended and were not retested and 43.9% did not re-attend. Within 1.5–12 months, 40% re-attended and were retested (16% tested positive), 40% re-attended and were not retested and 20% did not re-attend. Of individuals re-attending in 1.5–12 months but not retested, 50% had re-attended three or more times in the period. Within 6 weeks of a positive test, 25% were retested.
Discussion A high proportion of 16–29-year-olds re-attended general practices in the recommended retest periods, but retesting rates were low and multiple missed opportunities were common. The findings highlight the need for strategies such as electronic clinician prompts, patient recall systems and promotion of retesting guidelines.
- Chlamydia infections
- repeat testing
- general practice
- young adult
- family planning
- general practice
- epidemiology (clinical)
- epidemiology (general)
- bacterial infection
- primary care
Funding Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance was funded through the Australian Government Department of Health and Ageing Chlamydia Pilot Program from 2007 to 2010. The authors gratefully acknowledge the contribution to this work of the Victorian Operational Infrastructure Support Program. RG, MH, JH and BD are supported by NHMRC Fellowships.
Competing interests None.
Patient consent Waiver of consent for the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance project was approved by Royal Australian College of General Practitioners National Research and Evaluation Ethics Committee (ref. number 07/017).
Ethics approval Ethics approval was provided by Royal Australian College of General Practitioners National Research and Evaluation Ethics Committee. NREEC 07/017.
Provenance and peer review Not commissioned; externally peer reviewed.