GP Management of sexually-acquired Chlamydia infections in North Queensland Dr. Tracy Cheffins MBBS MPH FRACGP FAFPHM Scottish School of Primary Care Edinburgh 2011

Townsville, Australia

The Problem Prevalence of Chlamydia increasing Most research done in public clinics Most treatment done by private GPs Control requires treatment of partner contacts Evidence of inconsistent GP management of contact tracing

The Place

The Research Team Dr. Tracy Cheffins, NQPBRN* Ms. Margaret Spillman, NQPBRN A/Prof. Clare Heal, School of Medicine and Dentistry (Mackay) Dr. Monika Buhrer-Skinner, Qld Health sexual health unit A/Prof. Sarah Larkins, School of Medicine and Dentistry GPs and nurses, 9 General Practices in North Queensland *(North Queensland Practice Based Research Network)

The Questions Do GPs manage Chlamydia according to Queensland Health sexual health guidelines? Why do GPs refer for Chlamydia testing? What do GPs tell their patients?

The Methods Practice nurse audit of 12 months of positive Chlamydia cases diagnosed by practice GPs (n=176) Three month collection of “reason for referral” data for all Chlamydia tests referred by practice GPs (n=521) GP questionnaire on usual management and preferred contact tracing methods (n=35)

The Workforce

Results (1) - Audit N=176 Prescribed medication

Results (1) - Audit Results of follow up Chlamydia tests

Results (2) - Referrals N=521 Reasons for GP referral for Chlamydia test

Results (3) - GP survey N=35 How often GPs treat patients with symptoms of Chlamydia prior to receiving test results How quickly GPs ask to see patients after a positive test result

Results (3) - GP survey Length of time GPs advised patients to use condoms after treatment for Chlamydia infection.

Results (3) - GP survey Length of time to repeat test following treatment of Chlamydia infection.

Preferred methods for contact tracing ranked from most to least Electronic contact methods Printed resources GP access to an external contact tracer Direct register referral of ALL cases to contact tracer GP referral of ALL cases to contact tracer Very little support for the status quo (<10%)

Tropical Cyclone Yasi

NQPBRN 15 practices have participated in research (approx 45 GPs) Academic coordinator (0.4 FTE) Research worker (0.5 FTE) Started 2007 with RACGP grant for road trauma research study Funded by Australian Dept of Health and Ageing PHCRED* capacity building grant since 2008 Five completed studies Two studies for completion 2011 *(Primary Health Care Research Evaluation and Development program)

Completed Studies Rural GP management of chronic road crash trauma cases – GP survey GP management of acute otitis externa – audit, prospective data collection, GP survey Evaluation of over 75 years health assessments in General Practice – 2 projects - GP audit and patient survey Parent vaccination study – cross sectional patient survey with follow-up by practice nurses.

The Strategy Work with nurses rather than GPs Pay practices for nurse research time Provide research training for nurses Visit practices (with food) to recruit GPs and share results Ensure CPD points available for research Support network members to attend conferences, write papers Gentle persuasion and personal touch

The Visit