Nurse-led telephone management of patients with chlamydia and gonorrhoea could provide a better service for patients and reduce GP workloads, according to a study by researchers at the University of Bristol and NIHR ARC West published in BMC Family Practice.
Up to 18 per cent of chlamydia infections and 9 per cent of gonorrhoea infections in England are diagnosed in primary care. With the increase in sexually transmitted infections (STIs) and the emergence of antimicrobial resistance, their timely and appropriate treatment is a priority.
Currently, the National Chlamydia Screening Programme offers testing to young women and men (aged 15-24) to diagnose and control chlamydia infection. The service is telephone-based and managed centrally by specialist STI nurses. However, the service has so far been under-used by GPs.
The study piloted an extension of the NCSP’s nurse-led telephone management (NLTM) as an option to manage all patients with suspected chlamydia and gonorrhoea in primary care. Patients with negative results received a text from the service and positive patients received a telephone call from a specialist nurse. Any questions were answered, and appropriate treatment via a nominated pharmacy or sexual health clinic arranged along with partner treatment. Patients with positive gonorrhoea tests were referred to a STI clinic.
The aim of the pilot was to assess whether the NLTM system was acceptable to both patients and health care professionals, and whether it was possible to implement in a primary care setting. The trial took place in 11 GP practices in Bristol. In some of these practices (the intervention group), patients and GPs and nurses had the option of choosing NLTM for all patients tested for chlamydia and gonorrhoea. In other practices (the control group) patients received usual care.
The research team also interviewed GPs, nurses and patients to find out what they thought about the telephone management service.
In six months, 1,154 tests took place: 2.6 per cent were positive for chlamydia and 0.8 per cent positive for gonorrhoea. The telephone management service managed 335 patients’ cases. This demonstrated that patients testing for chlamydia and gonorrhoea could successfully be managed remotely by specialist nurses.
GPs and nurses were positive about the telephone management service and thought it could provide timely test results for patients and better partner notification if a patient’s test was positive. They thought the service could reduce their workload and reported that explaining the nurse-led telephone management service to patients didn’t negatively impact on consultations.
Patients found the telephone management service acceptable, more convenient and provided greater anonymity than usual care. Patients appreciated getting a text message about a negative result and valued talking to a sexual health specialist about positive results.
Dr Jeremy Horwood, Associate Professor in Social Sciences and Health at the Centre for Academic Primary Care/NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and ARC West and lead author of the study, said:
“Budget cuts for sexual health services in recent years mean patients are not always able to easily access specialist sexual health care. Increasingly the burden of diagnosis and management of STIs is falling on primary care. This comes at a time when general practice is already struggling under increased workload pressure, further exacerbated by the demands of the coronavirus pandemic.
“This study provides evidence that implementing the nurse-led telephone management approach across primary care in England is both acceptable and feasible to patients and clinicians and has the potential to provide a better service for patients and reduce GP workload at a critical time.”
Paddy Horner, Associate Professor in Sexually Transmitted Infections at The University of Bristol and consultant Physician in Sexual Health and HIV at Unity Sexual Health clinic, said:
“Timely testing and treatment, with the right antibiotic, of both the patient and their sexual partners is crucial when treating STIs to prevent reinfection, onward transmission and treatment failure, and avert further emergence of antimicrobial resistance. Managing positive chlamydia and gonorrhoea tests is complex, and guidelines change frequently. Sexual health specialists want to offer appropriate and timely expert support to our primary care colleagues to ensure the best outcomes for patients. The study provides evidence to support the wider implementation of this specialist telephone management approach to managing common STIs diagnosed in primary care. It could provide a better service for patients whilst decreasing GPs’ and nurses’ workloads, and contribute to better use of clinical resources and better patient outcomes.”
Paper: Management of chlamydia and gonorrhoea infections diagnosed in primary care using a centralised nurse-led telephone-based service: mixed methods evaluation by Jeremy Horwood, Emer Brangan, Petra Manley, Paddy Horner, Peter Muir, Paul North and John Macleod. Published in BMC Family Practice. December 2020.