EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE

Can we evaluate population screening strategies in UK general practice? A pilot randomised controlled trial comparing postal and opportunistic screening for genital chlamydial infection

Abiola Senok¹, Phil Wilson¹, Margaret Reid², Anne Scoular³, Neil Craig², Alex McConnachie¹, Bridie Fitzpatrick¹ and Alison MacDonald⁴

¹ General Practice and Primary Care, Division of Community Based Sciences, University of Glasgow, Glasgow, UK
² Public Health and Health Policy, Division of Community Based Sciences, University of Glasgow
³ Greater Glasgow NHS Board, Glasgow, UK
⁴ Bridgeton and Dennistoun LHCC, Bridgeton Health Centre, Glasgow, UK

Correspondence to:
Correspondence to:
Dr P Wilson
General Practice and Primary Care, Division of Community Based Sciences, University of Glasgow, 1 Horselethill Road, Glasgow G12 9LX, UK; p.wilson{at}clinmed.gla.ac.uk

Study objective: To assess whether opportunistic and postal screening strategies for Chlamydia trachomatis can be compared with usual care in a randomised trial in general practice.

Design: Feasibility study for a randomised controlled trial.

Setting: Three West of Scotland general medical practices: one rural, one urban/deprived, and one urban/affluent.

Participants: 600 women aged 16–30 years, 200 from each of three participating practices selected at random from a sample of West of Scotland practices that had expressed interest in the study. The women could opt out of the study. Those who did not were randomly assigned to one of three groups: postal screening, opportunistic screening, or usual care.

Results: 38% (85 of 221) of the approached practices expressed interest in the study. Data were collected successfully from the three participating practices. There were considerable workload implications for staff. Altogether 124 of the 600 women opted out of the study. During the four month study period, 55% (81 of 146) of the control group attended their practice but none was offered screening. Some 59% (80 of 136) women in the opportunistic group attended their practice of whom 55% (44 of 80) were offered screening. Of those, 64% (28 of 44) accepted, representing 21% of the opportunistic group. Forty eight per cent (59 of 124) of the postal group returned samples.

Conclusion: A randomised controlled trial comparing postal and opportunistic screening for chlamydial infection in general practice is feasible, although resource intensive. There may be problems with generalising from screening trials in which patients may opt out from the offer of screening.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

Values, rights, responsibilities, and public health—Oh yes, and avoid fornication!

Carlos Alvarez-Dardet and John R Ashton
J Epidemiol Community Health 2005 59: 177. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

• Wallace, L A, Scoular, A, Hart, G, Reid, M, Wilson, P, Goldberg, D J (2008). What is the excess risk of infertility in women after genital chlamydia infection? A systematic review of the evidence. Sex. Transm. Infect. 84: 171-175 [Abstract] [Full Text]  
• Sripada, S, Logan, S, McGillivray, S, Mckenzie, H, Templeton, A, Hamilton, M, Sutherland, A, Bhattacharya, S (2007). Opportunistic screening for Chlamydia trachomatis in men attending three different secondary healthcare settings. Sex. Transm. Infect. 83: 282-285 [Abstract] [Full Text]  
• Campbell, N. C, Murray, E., Darbyshire, J., Emery, J., Farmer, A., Griffiths, F., Guthrie, B., Lester, H., Wilson, P., Kinmonth, A. L. (2007). Designing and evaluating complex interventions to improve health care. BMJ 334: 455-459 [Full Text]  

eLetters:

Read all eLetters

Prevention of complications must be the primary outcome measure if a screening program is evaluated

Veronique Verhoeven, et al.

J Epidemiol Community Health Online, 16 Feb 2005 [Full text]