General practice potentially has an important role in the prevention and management of chlamydia in Australia, as most chlamydia infections are diagnosed in this setting. Although 80% of young adults attend their general practitioner (GP) annually, general practice chlamydia testing rates remain quite low. The Australian Chlamydia Control Effectiveness Pilot (ACCEPt) is a randomised controlled trial that aims to evaluate whether annual chlamydia testing for 16 to 29 year olds attending general practice can reduce the prevalence of chlamydia in the population.
ACCEPt drew on the Normalisation Process Theory (NPT) to guide the design of the intervention for this trial. NPT argues that successfully embedding a complex intervention into routine clinical practice requires a ‘whole of practice’ approach which engages all clinic staff including GPs, practice managers and practice nurses. The intervention designed to facilitate increased chlamydia testing in ACCEPt intervention clinics consisted of computer alerts, incentive payments to GPs and practice nurses for each chlamydia test conducted, quarterly audit and feedback on testing performance to individual GPs, GP and practice nurse training, and patient recall and reminders for follow-up testing. A total of 143 clinics servicing over 70,000 16 to 29 year olds were recruited across Victoria, Queensland, NSW and South Australia. Clinics where the practice manager was engaged and interested in research were better equipped to enable the establishment of a chlamydia testing pathway and the necessary systems to allow chlamydia testing to be successfully adopted within the clinic. Testing rates almost doubled in intervention clinics compared with control clinics (RR = 1.9; 95% CI: 1.8, 2.0). Following three years of intervention, the numbers of 16–29 year olds who were screened annually for chlamydia rose to approximately 27% of women and 15% of men in intervention clinics.
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