Strengthening chlamydia management in Australian general practice using interventions that align with clinic workflow: implementation and feasibility trial findings

ObjectiveTo evaluate the implementation and impact of the Management of Chlamydia Cases in Australia (MoCCA) intervention for strengthening chlamydia management in Australian general practice. DesignNon-randomised implementation and feasibility trial SettingGeneral practices in the Australian states of New South Wales, Queensland and Victoria. Participants14 general practices participated and implemented the MoCCA intervention. General practitioners (GPs) and nurses from participating clinics were interviewed about implementation and use of MoCCA. Deidentified patient attendance and clinical data for patients aged 16-44 years were collected for each clinic. InterventionMultifaceted intervention (website (www.mocca.org.au/), patient factsheets, shortcuts for documenting a chlamydia consultation, mailed specimen kits for chlamydia retesting, guidance articles, continuing professional development activities) to facilitate chlamydia management in general practice. Clinicians (GPs and nurses) were asked to use the MoCCA intervention to guide their chlamydia and pelvic inflammatory disease (PID) diagnosis and management over a 12-month intervention period. Main outcome measuresThe primary outcomes focussed on intervention implementation (acceptability, adoption, appropriateness, feasibility, fidelity, penetration, sustainability). Secondary outcomes focused on chlamydia retesting and reinfection among patients who had a chlamydia infection and PID rates among female patients, comparing the intervention period with a 12-month preintervention period. ResultsClinicians (doctors=26, nurses=7) largely viewed MoCCA as compatible (appropriateness) with the general practice setting and an acceptable approach to streamlining chlamydia management. Some MoCCA components (e.g. website, shortcuts, factsheets, patient delivered partner therapy [PDPT] resources) were preferred for their ease of use and support for decision making over other components (e.g. postal retesting kits). Intention to use MoCCA (adoption) and its uptake (penetration) varied between clinicians and MoCCA components. Some clinicians intended to use MoCCA but did not due to lack of opportunity, forgetting, or other preferred practices. MoCCA was not used uniformly (fidelity), but its flexible design let clinicians use MoCCA components to suit their needs. Clinicians liked that MoCCA facilitated best practice chlamydia management (feasibility) as outlined in Australian STI management guidelines. Reported improvements in care included better quality, continuity and time-efficiency (e.g. website simplified chlamydia management) and patient communication (e.g. shortcuts/factsheets remind to discuss retesting). Many wanted access to MoCCA resources post-study (sustainability). Chlamydia tests were conducted in 17.2% patients preintervention (n=7670/44607, with 4.6% positive) and 18.0% (n=9703/54008, with 5.0% positive) during the intervention. Proportions retested were 18.1% (95% confidence interval (CI) 13.4, 23.7) preintervention and 23.1% (95%CI 18.7, 28.1) in the intervention period (difference=5.0%, 95%CI -2.1, 12.1). Adjusting for gender and clinic location (metropolitan vs non-metropolitan), retesting for 16-25-year-olds increased between the preintervention and intervention period (adjusted relative risk (aRR) 2.12, 95%CI 1.43, 3.15) and for individuals aged 26-44 years results were inconclusive (aRR 1.01, 95%CI 0.66,1.55). PID diagnosis per 1000 consultations among females were 16.9 preintervention and 19.1 intervention period (absolute difference = 2.18%, 95% CI 0.13, 4.23). ConclusionsMoCCA aligned with the general practice setting and supported improved chlamydia management.