Chlamydia screening programs: a review of the literature. Part 2: Testing procedures and educational interventions for primary care physicians.

Abstract: Taking Action on Chlamydia Campaign, a social marketing campaign designed by Toronto Public Health, was implemented in response to rising rates of infection among young adults in the Toronto area. In the first phase of the project, the goal has been to reach primary care physicians with educational messages related to the prevalence of chlamydia infection, the need for screening, and the current testing practices available. The following literature review addresses two areas of research relevant to the first phase of the project: (1) elements of successful educational interventions designed to change physician clinical practices and patient outcomes and (2) the accuracy and acceptability of chlamydia/STI screening tests. The research regarding educational interventions for primary care physicians in outlined in Section I. The importance of multifaceted approaches to learning is clearly indicated in the literature. The use of a single method of information delivery is less effective than a combination of methods that motivate, facilitate and reinforce positive behavioural change among physicans in a clinical setting. Section II focuses on the current state of screening tests used in the diagnosis of chlamydia infections. The accuracy of available tests is discussed, as is the acceptability of various forms of testing among both physicians and patients.

Key words: Chlamydia, screening, physicians, continuing medical education.

Introduction

The Taking Action on Chlamydia social marketing campaign, initiated by Toronto Public Health, is designed to educate both primary care physicians and the public about Chlamydia, in an effort to increase testing and reduce the incidence of the infection. In the first phase of the project, the aim is to reach primary care physicians with information on the need for increased screening of adolescent and young adult women. In preparation for this educational outreach, a review of the literature was conducted to identify the most effective elements of interventions designed to change clinical practices. Section I outlines the key components of successful educational interventions as indicated in the research literature. Section II presents the current state of testing practices for the diagnosis of Chlamydia, with reference to the accuracy of available tests as well as to the acceptability of tests for both physicians and patients.

Section I: Educational Interventions

A review of the literature, both meta analyses and individual studies, indicate a number of key issues to consider in the design of a successful educational intervention for primary care physicians. The consideration of barriers to change is an important first step in designing an intervention. A successful educational intervention must demonstrate its clinical relevance as well as motivate, facilitate, and reinforce behavioural change. The importance of multi-faceted approaches to educational interventions is indicated in the literature. The combination of printed materials, online information, outreach visits and professional endorsement of information produce more positive and lasting changes than the use of a single method of information dissemination.

Meta Analyses