Uk national audit of chlamydial infection management
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UK National Audit of Chlamydial Infection Management. National Audit Group British Association for Sexual Health & HIV. Case notes audit Interim results. 20 February 2008. Case definition. Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval

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UK National Audit of Chlamydial Infection Management

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Uk national audit of chlamydial infection management

UK National Audit of Chlamydial Infection Management

National Audit Group

British Association for Sexual Health & HIV


Uk national audit of chlamydial infection management

Case notes audit

Interim results

20 February 2008


Case definition

Case definition

  • Any one of the KC60 C4A, C4B, or ISD(D)5 C41A, C41B or C41R and seen in the audit interval

  • GUM clinic or Sexual Reproductive Healthcare clinic

  • Audit interval: 2 January and 31 March 2007 inclusively

  • Sample number: first 30 patients seen in the audit interval (or all cases if less than 30 seen)

  • Data collected: 3 September 2007 to 31 October 2007


Demography

Demography


Uk national audit of chlamydial infection management

*Note: South East & South West Thames is “South Thames”

Essex data included in “North Thames”


Number of cases n 5032

Number of cases (N=5032)


Sample

Sample

*Health Protection Scotland: http://www.documents.hps.scot.nhs.uk/ewr/pdf2007/0720.pdf

† Health Protection Agency. Personal Communication


Reasons for testing more than 1 reason possible

Reasons for testingMore than 1 reason possible


Presenting features female cases n 2474

Presenting features: female cases (n=2474)


Presenting features male cases n 2546

Presenting features: male cases (n=2546)


Test method naats

Test method - NAATs

Overall, 4679 (93%, regional range 100-69%) cases had NAAT testing documented from at least one of urinary, cervical, vulvovaginal, urethral or rectal sampling


Other chlamydial tests

Other chlamydial tests


Chlamydial tests in women

Chlamydial tests in women

  • 2093 (85%) women had cervical or vaginal NAATs

  • of the remaining 381 not having cervical or vaginal NAATs

    • 134 (35%) had urine NAATs (of whom 52 (39%) had a genital examination performed)

    • 18 (5%) had urethral NAATS

    • 229 (60%) had no cervical, vulvovaginal, urinary or urethral NAATS


Chlamydial tests in men

Chlamydial tests in men

  • 1723 (68%) men had urinary NAATS

  • Of the remaining 823 not having urinary NAATs

  • 699 (85%) had urethral tests

  • 124 (15%) had neither urinary nor urethral tests


Other tests for stis syphilis

Other tests for STIs: Syphilis


Uk national audit of chlamydial infection management

Other tests for STIs: HIV


Treatment uncomplicated infxn

Treatment: uncomplicated infxn.


Treatment pregnant women

Treatment: pregnant women

  • Twenty of 26 pregnant women were treated with azithromycin

  • ?suggests that most prescribers treating pregnant women consider that erythromycin is not an “adequate alternative” to azithromycin (the manufacturer’s advice stated by the British National Formulary

British National Formulary. [http://www.bnf.org/bnf/bnf/current/126828.htm]. (Accessed 09 February 2008)


Information giving

Information-giving


Follow up modes of fu

Follow-up: modes of FU


Uk national audit of chlamydial infection management

Follow-up: time to FU


Partner notification

Partner notification


Ceg standard for contact tracing

CEG standard for contact tracing

  • Auditable Outcome Measures

    • Partner notification recommendation: In 2004, a systematic review of UK GUM clinics’ work showed that a mean of 0.43 contacts per case of chlamydia were screened in large city clinics and 0.64 contacts per case of chlamydia were screened in other clinics

http://www.bashh.org/guidelines/2006/chlamydia_0706.pdf


Uk national audit of chlamydial infection management

Note: please look at the corresponding question in the Case notes questionnaire for this table


Conclusions 1

Conclusions: 1

  • Largest national audit to date (more clinics)

    • 187 (71%) of the 262 UK GUMed clinics plus 6 SRH clinics

  • Ethnic group not always recorded 8% (0-32%)

  • 83% aged 19 years or over

  • Relatively few MSM overall (3% all cases)

  • About ½ cases no symptoms

  • 1/3 attending for routine or asymptomatic screens,

    • ?implications for service provision/workloadreduction


Uk national audit of chlamydial infection management

Conclusions: 2

  • Main test used are NAATs

  • Main testing sites in women are cervical or vulval

  • 73% MSM tested for HIV, range 58-100%

  • Main treatment is azithromycin (54% cases), but a lot of doxycycline is also used (37% cases)

  • Most pregnant women treated with azithromycin

  • Lack of written information provided (only 50% cases overall)

  • More follow-up done by ‘phone or texting than in clinic

  • 25% cases no FU


Conclusions 3

Conclusions: 3

  • >90% of cases having PN had this provided by a HA or other suitably trained HCP

  • PN outcomes not documented for 25% cases provided with PN advice

  • 40% cases not documented as having treatment verified for contact(s), with wide range 0-51%

  • The national estimate of average number of contacts screened per index was 0.45, with regional performances between 0.29 to 0.73


Uk national audit of chlamydial infection management

… the end


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