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Missed opportunities for chlamydia screening by community pharmacists

Missed opportunities for chlamydia screening by community pharmacists The National Chlamydia Screening Program (NCSP) offers screening for genital chlamydia ( Chlamydia trachomatis ) infections to young people aged under 25 years in England through different approaches such as general practices, internet-ordered screening kits and community pharmacies (CPs). CPs are an ideal way of delivering screening, as young sexually active women use CPs to access emergency hormonal contraception (EHC), regular oral contraceptives and pregnancy tests, and have shown to be safe and practical. 1 However, CPs continue to provide only a minority of screens within the NCSP (2% between April 2008 and March 2009). 2 As users of these services fit the same target group for the NCSP, it is essential to optimise uptake of chlamydia screening in this environment. We therefore decided to audit the uptake of chlamydia screening among women aged up to 21 years accessing free EHC from CPs within Greenwich, a deprived borough in south-east London. The audit was restricted to women aged under 21 years, as this is the age limit for free EHC in CPs. (This local scheme was developed before the national introduction of NCSP, which is why the respective age ranges differ.) CP records for EHC during the period 1 April 2009 to 31 May 2009 were inspected. These were checked for documented offers and acceptance of chlamydia screening kits. Additionally, the numbers of screening kits originating from CPs were identified from routine monitoring data. The aspirational standard was for 50% of EHC users to be offered chlamydia screening; this was chosen as a pragmatic measure for a first audit where no national standard existed. During this 3-month period, 215 women aged up to 21 years were given free EHC from local community pharmacies. Of these, only 12 (5.6% of all EHC users; 95% confidence interval (CI): 2.5–8.6%) had a documented offer of a chlamydia screening kit. Only eight women accepted chlamydia screening kits. In total, during that period, only seven chlamydia screening kits from CPs were returned to the chlamydia screening program in Greenwich. This is equivalent to 3.3% (95% CI: 0.9–5.6%) of all women up to the age of 21 receiving free EHC through local CPs. This audit has identified that chlamydia screening offers, uptake and completion among women accessing a free EHC service in CPs requires further improvement. CPs are potentially important venues for chlamydia screening, as they are used for services related to sexual health, such as planned oral contraception and pregnancy testing. However, CPs constitute only a small proportion of chlamydia screening activity on a national basis. 2 Therefore, improving uptake is an important issue to the whole program. Low uptake of pharmacy-based chlamydia screening is not just limited to England but has also been observed in a similar scheme in The Netherlands. 3 Qualitative research has identified that pharmacists assume EHC users to be a natural target group for chlamydia screening, 4 yet on the basis of this audit, this approach appears to be limited in success. Identified barriers to increasing screening activity include concerns over confidentiality, volumes of competing pharmacy work and perceived potential of offending customers. 4 , 5 We suggest that supportive training for pharmacists and integrating chlamydia screening into local EHC contracts are measures that may help increase screening activity in this important community-based setting. These findings were presented at the 2010 BASHH/BHIVA conference . http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Sexual Health CSIRO Publishing

Missed opportunities for chlamydia screening by community pharmacists

Dabrera Gavin; Pinson David; Whiteman Steve
Sexual Health , Volume 9 (3) – Mar 30, 2012
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Publisher
CSIRO Publishing
Copyright
CSIRO
ISSN
1448-5028
eISSN
1449-8987
DOI
10.1071/SH11109
pmid
22697148
Publisher site
See Article on Publisher Site

Abstract

The National Chlamydia Screening Program (NCSP) offers screening for genital chlamydia ( Chlamydia trachomatis ) infections to young people aged under 25 years in England through different approaches such as general practices, internet-ordered screening kits and community pharmacies (CPs). CPs are an ideal way of delivering screening, as young sexually active women use CPs to access emergency hormonal contraception (EHC), regular oral contraceptives and pregnancy tests, and have shown to be safe and practical. 1 However, CPs continue to provide only a minority of screens within the NCSP (2% between April 2008 and March 2009). 2 As users of these services fit the same target group for the NCSP, it is essential to optimise uptake of chlamydia screening in this environment. We therefore decided to audit the uptake of chlamydia screening among women aged up to 21 years accessing free EHC from CPs within Greenwich, a deprived borough in south-east London. The audit was restricted to women aged under 21 years, as this is the age limit for free EHC in CPs. (This local scheme was developed before the national introduction of NCSP, which is why the respective age ranges differ.) CP records for EHC during the period 1 April 2009 to 31 May 2009 were inspected. These were checked for documented offers and acceptance of chlamydia screening kits. Additionally, the numbers of screening kits originating from CPs were identified from routine monitoring data. The aspirational standard was for 50% of EHC users to be offered chlamydia screening; this was chosen as a pragmatic measure for a first audit where no national standard existed. During this 3-month period, 215 women aged up to 21 years were given free EHC from local community pharmacies. Of these, only 12 (5.6% of all EHC users; 95% confidence interval (CI): 2.5–8.6%) had a documented offer of a chlamydia screening kit. Only eight women accepted chlamydia screening kits. In total, during that period, only seven chlamydia screening kits from CPs were returned to the chlamydia screening program in Greenwich. This is equivalent to 3.3% (95% CI: 0.9–5.6%) of all women up to the age of 21 receiving free EHC through local CPs. This audit has identified that chlamydia screening offers, uptake and completion among women accessing a free EHC service in CPs requires further improvement. CPs are potentially important venues for chlamydia screening, as they are used for services related to sexual health, such as planned oral contraception and pregnancy testing. However, CPs constitute only a small proportion of chlamydia screening activity on a national basis. 2 Therefore, improving uptake is an important issue to the whole program. Low uptake of pharmacy-based chlamydia screening is not just limited to England but has also been observed in a similar scheme in The Netherlands. 3 Qualitative research has identified that pharmacists assume EHC users to be a natural target group for chlamydia screening, 4 yet on the basis of this audit, this approach appears to be limited in success. Identified barriers to increasing screening activity include concerns over confidentiality, volumes of competing pharmacy work and perceived potential of offending customers. 4 , 5 We suggest that supportive training for pharmacists and integrating chlamydia screening into local EHC contracts are measures that may help increase screening activity in this important community-based setting. These findings were presented at the 2010 BASHH/BHIVA conference .

Journal

Sexual Health – CSIRO Publishing

Published: Mar 30, 2012

Keywords: England, London, National Chlamydia Screening Program.

References

  • Chlamydia testing in community pharmacies: evaluation of a feasibility pilot in south east London.
    Baraitser P Pearce V Holmes J Horne N Boynton PM
  • Effectiveness and cost-effectiveness of a pharmacy-based screening programme for Chlamydia trachomatis in a high-risk health centre population in Amsterdam using mailed home-collected urine samples.
    van Bergen JE Postma MJ Peerbooms PG Spangenberg AC Tjen-A-Tak J Bindels PJ
  • Chlamydia screening by community pharmacists: a qualitative study.
    Dabrera G Pinson D Whiteman S
  • A qualitative study of pharmacists’ views on offering chlamydia screening to women requesting emergency hormonal contraception.
    Thomas G Humphris G Ozakinci G O’Brien K Roberts SA Hopkins M Brabin L