Pathfinder Chlamydia Screening PilotPresented by Rebecca Adeojo on behalf of :Danielle Mercey(1) Tina Sharp(2) Jill Martin(3) Julie Hamner(4)1) UCL 2) Camden PCT 3) DoH 4) Boots Boots is providing chlamydia screening and treatment on behalf of the NHS
Overview • Methods • Testing and treatment • Training programme • Marketing • Contract monitoring • Results to date • Summary
Background • DH tender to provide chlamydia screening to young people in rural and urban community pharmacies. • Boots the Chemist awarded contract for London. • Complementary to National Chlamydia Screening Project.
Objective To test and evaluate the effectiveness of high street community pharmacies as an access point for screening and treatment for genital chlamydia infection
Methods • Available in 215 Boots stores within 31 London PCTs, from 14th November 2005 • Two year pathfinder project
Chlamydia Screening Service Boots are providing free Chlamydia screening to 16 - 24 year olds in all stores in the London area. Client collects test kit & information booklet from Pharmacy counter Client returns with a urine sample Sample tested at laboratory using PCR (Roche) Client receives test result within 3 business days
Test Kit • Test kit contains: • Urine sample pot • Instructions • ‘Self-complete’ request form (same data as National Chlamydia Screening Programme)
Result Notification • Boots notify all negative clients, and those that require a retest • Clients can be notified of results via text, letter or phone • Pathfinder CSO (Camden Chlamydia Screening Office) notify all positive clients
Treatment • Treatment can be given by Boots stores • Azithromycin first line • Doxycycline second line • Patient Group Directions (to be hosted by Camden PCT).
Chlamydia Positive Results Positive results received from Boots daily CSO contacts client by requested method: phone, text or letter Explain result, initiate PN, triage for treatment If within PGD criteria, offered option of free treatment at any Boots in London or GU Clinics If does not meet PGD criteria, Explore options: GU clinics, general practice …. Arrange appt & referral letter with outcome form.
Partner Notification Partners aged 16+ years can go to Boots for free treatment if within PGD criteria (no upper age limit) Partners not meeting PGD criteria will be assisted to access NHS GU Services As partner not screened, CSO will contact partner before and/or after treatment to ask about other sexual contacts in previous six months. Their partners will be encouraged to screen.
Ongoing Management in CSO CSO Monitors if client and partners have received: • Treatment (& where) • Initiate PN discussion • Follow-up compliance • PN resolution • Option of further STI screen • Sexual health education
Training PHARMACIST TRAINING • Coordinated training programme • Medical Director, Pharmacy Superintendent, Legal Advisor • Distance learning pack and workshop attendance • Competency assessment (Q & As and case study) • Senior area pharmacist sign off STAFF TRAINING • Pharmacy staff • Store staff • Non participating stores
Marketing Materials • Increase awareness of service • Posters, flyers, hanging cards, window displays • Remove barriers to testing • Vouchers • Information • Information leaflet
Contract Monitoring Key features include • Weekly activity data • Key performance indicators • Incident reporting • Independent evaluation • Financial penalties
Contract Management Structure • Contract Advisory Board – Quarterly: Key stakeholders and evaluation team • Joint Service Reviews – Monthly: Boots, DH and Lead PCT
Contract Advisory Board • DH Leads (Sexual Health Policy and Commercial Directorate) • Provider Lead Boots Project Manager • Pathfinder CSO • London wide SHA Sexual Health Lead • Clinical Advisors - GUM, Microbiology, Family planning, Pharmacy • Camden Clinical Governance Lead • Evaluation Lead
Contract Advisory Board Role • Representing the views of clinical groups in services the PCSPf contract affects • Identifying issues arising from service design and implementation, which may impact on associated services • Review activity and KPI information and advising on ways of maximising service impact • Undertake risk assessment on clinical governance and advising on maximising safe clinical governance and minimising clinical risk • Advise on membership of panels for Joint Service Investigations • Consider interim results of the independent evaluation
Joint Service Review • Performance monitoring • Activity • Key Performance Indicators • Incidents and complaints • Investigations • Rectification plans • Sanctions • Changes
Clinical Governance • PGD to be hosted by Camden PCT • Governance of treatment services to be undertaken by Camden PCT
Tests performed November 2005 to May 2006 • 17,763 kits issued • 7,362 samples returned (41%) • 646 positive samples (9%)
Number of Clients seen in GUM clinics 31% of positive clients treated in GUM clinics
Partner outcomes For 413 clients, 239 partners have been confirmed as treated (0.58 contacts per case)
Summary • Seems acceptable • Good follow up and PN rates • Await independent evaluation