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PERFORMANCE QUICK GUIDE PUBLIC HEALTH PERFORMANCE IMPROVEMENT CHLAMYDIA Vital Signs Indicator Prevalence of Chlamydia Rationale Chlamydia is the most common sexually transmitted infection (STI) and there is evidence that up to one in 10 young people aged under 25 may be infected. It often has no symptoms, but if left untreated can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydia is very easily treated. The national chlamydia screening programme (NCSP) has a community focus and concentrates on opportunistic screening of asymptomatic sexually active men and women under the age of 25 who would not normally access, or be offered a chlamydia test, and focuses on screening in non-traditional sites. Metrics Units: - the % of age 15-24 year old population screened for Chlamydia. The target for 2009-10 is 25% and for 2010-11 is 35% screened. Numerator 1 The actual number of 15-24 year old persons tested for chlamydia (excluding tests at GUM clinics) Denominator 1 PCT Population aged 15-24 years Indicator 1 The indicator is the numerator divided by the denominator, expressed as a percentage Numerator 2 The planned number of 15-24 year old persons tested for chlamydia (excluding tests at GUM clinics) Denominator 2 PCT Population aged 15-24 years Indicator 2 The indicator is the numerator divided by the denominator, expressed as a percentage Overall indicator This indicator will be indicator 1 divided by indicator 2, expressed as a percentage. Organisations’ Delivery Setup and Commissioning 1.Is there an identified Board Executive from each organisation with the responsibility to deliver the Chlamydia screening target? 2.Is there a Board-sponsored strategic commissioning plan with milestones based on a robust needs assessment that includes measuring demand and capacity to achieve the screens in Providers? 3.Is there a robust assessment of the model of service provision that is segmented and involves both “core” Primary Care and Sexual Health services and other options such as outreach, mail-outs? 4.Is there a decentralised model of the Chlamydia Screening Office (CSO) as a central point of co-ordination, service development, quality assurance and data collection rather than provider of treatment and partner notification. 5. Do you have targets for “foot-fall” in your contracts with services? For example, ensuring delivery of the target through Core Services will provide more sustainable delivery of screening. As a proportion of your total screening volume, screens from core services should contribute around 2/3 of screens. Higher proportions are acceptable, as long as some work is undertaken to address young people from vulnerable groups who tend not to access core services. Core services include: 6. Do you have a GP champion for Chlamydia screening in the PCT? Is there a robust LES’ in place for screening in General Practice? Up to 70% of young people in the 15-24 age group visit their GP in any year. This is an ideal setting to screen for chlamydia. There is a need to provide additional training, support and communication to practices; this can be in the form of a GP champion, who can support practices in reaching the target. The LES has to be commensurate with the work undertaken, therefore screening, treating and testing should have differential rates according to time taken, in addition, tiered LES, with bonuses on reaching targets has shown to improve rates. The NCSP can provide guidance on LES. Organisations’ Delivery Setup and Commissioning 7. Do you have a SLA for Chlamydia screening with Community Contraception Services(CCS) that renumerates the service for the activity on a PbR-type basis? It is important to identify ‘footfall’ of young people in the age group to identify the potential of the service. CCS should be contracted to offer testing to 100% of patients attending with a target of around 80% agreeing to screen. 8. Do you have an enhanced service for Chlamydia screening and treatment from Pharmacies? Pharmacies are playing an increasing role in sexual health, and can be part of the chlamydia screening core provision. Currently numbers of screens being delivered in pharmacy is low, however, there is some evidence as to what works, including having a toilet on site, and motivated staff who are able to talk to young people about this issue in a non-judgmental way. The changes in Azithromycin from POM to P and commercially available chlamydia testing is increasing pharmacy engagement work with sexual health. 9. Have you commissioned Mailouts to young people registered with GPs in your PCT so that they can order a Chlamydia screening kit via a website? This can provide a boost in screening numbers, although programmes should not rely solely on this method to reach the target. There is guidance on maximising mailouts which can be found at http://www.chlamydiascreening.nhs.uk/ps/assets/files/MailOutGuidelines_v1_Nov_2008.pps 10. Have you ensured that the Non-NSCP, non-GUM Chlamydia screens are collated for your PCT? Studies show that some programmes still have a significant number of tests undertaken outside of NCSP and these will contribute to achieving the target. You may wish to be part of the London scheme where an information officer collects and analyses the data for you (c£2K/PCT if all London PCTs are engaged). You can join this via the London Sexual Health Programme ([email protected]) 11. Have you agreed a robust Evaluation strategy to strengthen the evidence base of effective interventions? The NCSP is leading on ensuring that all programmes evaluate their initiatives, however small, as they can all be useful to develop a full database of evidence that will be available to all working in chlamydia screening. There is an evaluation template available on the NCSP website. Data Quality 1. It is important that chlamydia screening offices (CSOs) are provided with adequate electronic databases to collate core and partner notification data, and to run reports as necessary. This will reduce time taken for data entry and thus free up staff for other roles, as well as ensure data quality and improve performance management and data monitoring capability. 2. The VSI target includes both NCSP and non-NCSP/non-GUM data. Non NCSP non GUM data must be submitted from Jan 2009 and from April 2009 must be submitted quarterly along with NCSP data. It is important that the laboratories are aware of the importance of this data and timely collection. (Chlamydia VSI Guidance – gateway ref 9952) 3. It is possible to ask clients to be recalled after a year, and a simple call/recall system can be established as an adjunct to the local programme. This will support the year on year increase in the target, and ensure that young people who have been tested are aware of the need to retest after 1 year. 4. The NCSP sets up internal trajectories for programmes on a quarterly basis. These are backloaded, based on evidence that programmes tend to aim for more test in the latter part of the year. These are helpful for Programmes to benchmark their performance over the year. ( http://www.chlamydiascreening.nhs.uk/ps/data/LDP_data.html) Evidence of Effective NHS Intervention Annual reports of the National Chlamydia Screening Programme in England, 2003/04, and 2004/05, HPA website: http://www.hpa.org.uk/infections/topics_az/hiv_and_sti/sti-chlamydia/chlamydia.htm Chlamydia Screening Programme Roll Out Data Manual: http://www.dh.gov.uk/assetRoot/04/07/44/60/04074460.pdf Link to the Commissioning quick wins http://www.chlamydiascreening.nhs.uk/ps/publications/qwins.html Top Tip 1.Ensure that you invest time and resources in developing a sustainable service for the future. Outreach and special events, whilst bringing in numbers in the short term, will not leave any legacy of chlamydia screening once the funding is gone. If chlamydia screening is embedded in core services, then screening will be secured longer term and is likely to be at a lower cost per screen.