UK National Audit of Chlamydial Infection Management in Sexual Health Clinics. Clinic policies audit

INTRODUCTION

This paper accompanies the two papers on the case note audit of chlamydial infection management carried out in 2007 by the National Audit Group. ^1,2

METHODS

The audit methodology and organization is described in an accompanying paper. ¹ This part of the audit provides data that allow comparisons of clinic policy with regards to the management of chlamydial infection, to be made between Regions, as well as to national average performance and National Guidelines. ³ Data aggregated by National Health Service Trusts within Regions, not published in this paper, has been provided to Chairs of Regional Audit Groups to allow service comparisons between Trusts. All data ranges given are regional ranges.

RESULTS

DISCUSSION

This audit on clinic policy supports the finding in the case notes part of the audit that nearly all clinics are using NAATs for chlamydial detection as recommended by the National Guideline. The reported provision of leaflets on chlamydia contrasts with the proportion of patients who actually received written information in the case notes part of the audit. ² This suggests a gap between policy and practice that might be improved by affected clinics reviewing how information is given. The provision of written information accompanying treatments supplied under Patient Group Directives (PGD) is a legal requirement in England. ⁴

The finding that follow up by telephone or text is now common policy is consistent with the case notes part of the audit and with advice offered in the National Guideline. ³ About one-quarter of clinics have a policy of providing a test of cure, where this is recommended, within an interval shorter than that recommended by the National Guideline.

The National Guideline does not stipulate, which health-care workers provide advice on partner notification, treatment adherence, safer sex advice and sexual abstinence, and this audit shows that this role is largely shared between different health-care workers.

Overall, many English clinics cooperate with their NCSP local Screening Programme coordinators. The case notes part of the Audit ¹ showed significant workload within clinics involving asymptomatic screening. These findings suggest that closer working between clinics and local Chlamydia Screening Programmes might help with initial case management. However, there is a wide regional variation in all aspects of clinic cooperation with local Screening Programmes. In particular, one-third of clinics overall do not cooperate with regard to partner notification, practice not in keeping with the NCSP recommendation that ‘A close working relationship and liaison with the local chlamydia screening office, chlamydia coordinator and Health Advising Team/genitourinary (GU) medicine service is essential.’ ⁵ Similarly, only 70% of clinics cooperate with regards to treatment in local Screening Programmes. This might be expected to have been higher, given the NSCP recommendation that all screen-positive participants, particularly those with symptoms, be offered the opportunity to attend a GU medicine clinic.

CONCLUSIONS AND SUGGESTED AREAS FOR PRACTICE IMPROVEMENT/INTERVENTIONS

Clinics not already doing so should use NAATs for chlamydial detection. Clinics not already doing so should cooperate with local NCSP Screening Programmes with regards to partner notification, treatment and policy-making. Written information should be given to all patients with chlamydia, and there is a legal requirement to do this when treatment is supplied under a PGD in England. Clinics not already doing so should have a policy of providing tests of cure, where this is recommended, based on the National Guideline interval of five or more weeks (six weeks if azithromycin). Clinics should consider follow up by telephone or text.

Detailed data, aggregated by regions, are available on the BASHH website: [http://www.bashh.org/committees/nag/index.htm]