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Slurink I, Groen K, Gotz HM, Meima A, Kroone MM, Hogewoning AA, Ott A, Niessen W, Dukers-Muijers N, Hoebe C, Koedijk F, Kampman C, van Bergen J. Contribution of general practitioners and sexual health centres to sexually transmitted infection consultations in five Dutch regions using laboratory data of Chlamydia trachomatis testing. Int J STD AIDS 2020; 31:517-525. [PMID: 32131701 DOI: 10.1177/0956462420905275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Effective sexually transmitted infection (STI) control requires opportunities for appropriate testing, counselling and treatment. In the Netherlands, people may attend general practitioners (GPs) and sexual health centres (SHCs; also known as STI clinics) for STI consultations. We assessed the contribution of GPs and SHCs to STI consultations in five Dutch regions with different urbanization levels, using data of urogenital Chlamydia trachomatis (CT) testing. Data (2011–2016) were retrieved from laboratories, aggregated by gender and age group (15–24 and 25–64 years). Results show that test rates and GP contribution varied widely between regions. GP contribution decreased over time in Amsterdam (60–48%), Twente (79–61%), Maastricht (60–50%) and Northeast-Netherlands (82–77%), but not in Rotterdam (65–67%). Decreases resulted from increases in SHC test rates and slight decreases in GP test rates. GPs performed more tests for women and those aged 25–64 years compared to SHCs (relative risks ranging from 1.49 to 4.76 and 1.58 to 7.43, respectively). The average yearly urogenital CT positivity rate was 9.2% at GPs and 10.7% at SHCs. Overall, GPs accounted for most STI consultations, yet SHC contribution increased. Continued focus on good quality STI care at GPs is essential, as increasing demands for care can not be entirely covered by SHCs.
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Affiliation(s)
- Ial Slurink
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - K Groen
- Department of Pulmonology, Interstitial Lung Diseases Center of Excellence, St Antonius Hospital, Nieuwegein, The Netherlands
| | - H M Gotz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands.,Department of Public Health, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - A Meima
- Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - M M Kroone
- Department of Infectious Diseases, Municipal Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - A A Hogewoning
- Department of Infectious Diseases, Municipal Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - A Ott
- Department of Medical Microbiology, Certe, Groningen, The Netherlands
| | - W Niessen
- Municipal Public Health Service Groningen, Groningen, The Netherlands
| | - Nhtm Dukers-Muijers
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Cjpa Hoebe
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,Department of Sexual Health, Infectious Diseases and Environmental Health, South Limburg Public Health Service, Heerlen, The Netherlands
| | - Fdh Koedijk
- Public Health Service Twente, Enschede, The Netherlands
| | - Cjg Kampman
- Public Health Service Twente, Enschede, The Netherlands
| | - Jeam van Bergen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Department of General Practice, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,STI AIDS Netherlands (SOA AIDS Nederland), Amsterdam, The Netherlands
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Prescription of Antibiotics to Treat Gonorrhoea in General Practice in Flanders 2009-2013: A Registry-Based Retrospective Cohort Study. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2017; 2017:1860542. [PMID: 28831325 PMCID: PMC5555009 DOI: 10.1155/2017/1860542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/28/2017] [Accepted: 03/15/2017] [Indexed: 11/18/2022]
Abstract
Background General practitioners (GPs) as a group have been identified as playing an important role in gonorrhoea management in Flanders. Belgian guidelines recommended ceftriaxone or alternatively spectinomycin from 2008 onwards and azithromycin combination therapy since 2012. Objectives This study investigates to which extent contemporary gonorrhoea treatment guidelines were followed. Methods A retrospective cohort study (2009–2013) of antibiotic prescriptions for gonorrhoea cases registered in the Flemish Intego general practice database was carried out. The database is based on electronic health record routine registration by over 90 GPs using the software programme Medidoc. Results Ninety-one gonorrhoea cases with ten chlamydia and one genital trichomonas coinfections in 90 patients were registered between 2009 and 2013. The proportion of cases with ceftriaxone and/or spectinomycin prescriptions rose from 13% (two of 15 cases) in 2009 to 56% (nine of 16 cases) in 2013. Combination therapy of ceftriaxone and/or spectinomycin together with azithromycin rose from 0 of 15 cases (0%) in 2009 to 7 of 16 cases (44%) in 2013. Conclusion Although numbers are small, the results suggest that gonorrhoea therapy guideline adherence improved between 2009 and 2013.
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Schweikardt C, Goderis G, Elli S, Coppieters Y. Gonorrhoea and Syphilis Epidemiology in Flemish General Practice 2009-2013: Results from a Registry-based Retrospective Cohort Study Compared with Mandatory Notification. AIMS Public Health 2016; 3:800-822. [PMID: 29546196 PMCID: PMC5690406 DOI: 10.3934/publichealth.2016.4.800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 09/13/2016] [Indexed: 11/27/2022] Open
Abstract
Background The number of newly diagnosed gonorrhoea and syphilis cases has increased in Flanders in recent years. Our aim was to investigate, to which extent these diagnoses were registered by general practitioners (GPs), and to examine opportunities and limits of the Intego database in this regard. Methods Data from a retrospective cohort study based on the Flemish Intego general practice database was analyzed for the years 2009–2013. Case definitions were applied. Due to small case numbers obtained, cases were pooled and averaged over the observation period. Frequencies were compared with those calculated from figures of mandatory notification. Results A total of 91 gonorrhoea and 23 syphilis cases were registered. The average Intego annual frequency of gonorrhoea cases obtained was 11.9 (95% Poisson confidence interval (CI) 9.6; 14.7) per 100,000 population, and for syphilis 3.0 (CI 1.9; 4.5), respectively, while mandatory notification was calculated at 14.0 (CI: 13.6, 14.4) and 7.0 (CI: 6.7, 7.3), respectively. Conclusion In spite of limitations such as small numbers and different case definitions, comparison with mandatory notification suggests that the GP was involved in the large majority of gonorrhoea cases, while the majority of new syphilis cases did not come to the knowledge of the GP.
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Affiliation(s)
- Christoph Schweikardt
- Université libre de Bruxelles (ULB), School of Public Health, Research Center 2: Epidemiology, Biostatistics, and Clinical Research; Research Center 3: Health Policies and Systems-International Health, Brussels, Belgium
| | - Geert Goderis
- Catholic University Leuven, Academic Center for General Practice, Leuven, Belgium
| | - Steven Elli
- Catholic University Leuven, Academic Center for General Practice, Leuven, Belgium
| | - Yves Coppieters
- Université libre de Bruxelles (ULB), School of Public Health, Research Center 2: Epidemiology, Biostatistics, and Clinical Research; Research Center 3: Health Policies and Systems-International Health, Brussels, Belgium
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Woestenberg PJ, van Oeffelen AAM, Stirbu-Wagner I, van Benthem BHB, van Bergen JEAM, van den Broek IVF. Comparison of STI-related consultations among ethnic groups in the Netherlands: an epidemiologic study using electronic records from general practices. BMC FAMILY PRACTICE 2015; 16:70. [PMID: 26084618 PMCID: PMC4470336 DOI: 10.1186/s12875-015-0281-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/18/2015] [Indexed: 11/29/2022]
Abstract
Background Currently, surveillance of sexually transmitted infections (STIs) among ethnic minorities (EM) in the Netherlands is mainly performed using data from STI centers, while the general practitioner (GP) is the most important STI care provider. We determined the frequency of STI-related episodes at the general practice among EM, and compared this with the native Dutch population. Methods Electronic medical records from 15–to 60-year-old patients registered in a general practice network from 2002 to 2011 were linked to the population registry, to obtain (parental) country of birth. Using diagnoses and prescription codes, we investigated the number of STI-related episodes per 100,000 patient years by ethnicity. Logistic regression analyses (crude and adjusted for gender, age, and degree of urbanization) were performed for 2011 to investigate differences between EM and native Dutch. Results The reporting rate of STI-related episodes increased from 2004 to 2011 among all ethnic groups, and was higher among EM than among native Dutch, except for Turkish EM. After adjustment for gender, age, and degree of urbanization, the reporting rate in 2011 was higher among Surinamese [Odds Ratio (OR) 1.99, 95 % confidence interval (CI) 1.70-2.33], Antillean/Aruban (OR 2.48, 95 % CI 2.04-3.01), and Western EM (OR 1.24, 95 % CI 1.11-1.39) compared with native Dutch, whereas it was lower among Turkish EM (OR 0.48, 95 % CI 0.37-0.61). Women consulted the GP relatively more frequently regarding STIs than men, except for Turkish and Moroccan women. Conclusions Most EM consult their GP more often for STI care than native Dutch. However, it remains unclear whether this covers the need of EM groups at higher STI risk. As a first point of contact for care, GPs can play an important role in reaching EM for (proactive) STI/HIV testing. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0281-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Petra J Woestenberg
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Aloysia A M van Oeffelen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Irina Stirbu-Wagner
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Birgit H B van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jan E A M van Bergen
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. .,STI AIDS Netherlands, Amsterdam, The Netherlands. .,Department of General Practice, Academic Medical Center, Amsterdam, The Netherlands.
| | - Ingrid V F van den Broek
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
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Hansen C, Adams M, Fox DJ, O'Leary LA, Frías JL, Freiman H, Meaney FJ. Exploring the feasibility of using electronic health records in the surveillance of fetal alcohol syndrome. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2014; 100:67-78. [PMID: 24591358 PMCID: PMC4601899 DOI: 10.1002/bdra.23207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/20/2013] [Accepted: 10/13/2013] [Indexed: 12/31/2022]
Abstract
BACKGROUND Explore the use of electronic health records (EHRs) in fetal alcohol syndrome (FAS) surveillance systems. METHODS Using EHRs we identified diagnoses and anthropometric measurements related to the FAS criteria developed by the Fetal Alcohol Syndrome Surveillance Network (FASSNet) among children aged 0 to 12 years. RESULTS There were 143,393 distinct children aged between 0 and 12 years enrolled in Kaiser Permanente, Georgia, during the study period. Based on diagnoses and anthropometric measurements, 20,101 children met at least one criterion of interest, and when grouped into combinations of different criteria there were 2285 who met GROWTH+CNS criteria, 76 children who met GROWTH+FACE criteria, 107 children who met CNS+FACE criteria, and 93 children who met GROWTH+CNS+FACE criteria. The prevalence of FAS as defined by FASSNet is 1.92 per 1000 children. We linked 17,084 (85.0%) children to their mothers in the health plan; only 3% of mothers of children in the GROWTH+CNS+FACE group had an indication of alcohol or drugs use, but they had the highest rate of depression (39%). CONCLUSION Data of utility in identification of FAS are readily available in EHRs and may serve as a basis for intervention with at-risk children and in planning of future FAS surveillance programs.
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Affiliation(s)
- Craig Hansen
- Center for Health Research, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Marvin Adams
- Center for Health Research, Kaiser Permanente Georgia, Atlanta, Georgia
| | | | - Leslie A. O'Leary
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jaime L. Frías
- Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
- McKing Consulting Corporation, Fairfax, Virginia
| | - Heather Freiman
- Center for Health Research, Kaiser Permanente Georgia, Atlanta, Georgia
| | - F. John Meaney
- Department of Pediatrics, University of Arizona, Tucson, Arizona
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Trienekens SCM, van den Broek IVF, Donker GA, van Bergen JEAM, van der Sande MAB. Consultations for sexually transmitted infections in the general practice in the Netherlands: an opportunity to improve STI/HIV testing. BMJ Open 2013; 3:e003687. [PMID: 24381253 PMCID: PMC3884819 DOI: 10.1136/bmjopen-2013-003687] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In the Netherlands, sexually transmitted infection (STI) care is provided by general practitioners (GPs) as well as by specialised STI centres. Consultations at the STI centres are monitored extensively, but data from the general practice are limited. This study aimed to examine STI consultations in the general practice. DESIGN Prospective observational patient survey. SETTING General practices within the nationally representative Dutch Sentinel GP network (n=125 000 patient population), 2008-2011. OUTCOME MEASURES GPs were asked to fill out a questionnaire at each STI consultation addressing demographics, sexual behaviour and laboratory test results. Patient population, testing practices and test positivity are reported. PARTICIPANTS Patients attending a consultation concerning an STI/HIV-related issue. RESULTS Overall, 1 in 250 patients/year consulted their GP for STI/HIV-related problems. Consultations were concentrated among young heterosexuals of Dutch origin. Laboratory testing was requested for 83.3% of consultations. Overall consult positivity was 33.4%, highest for chlamydia (14.7%), condylomata (8.7%) and herpes (6.4%). 32 of 706 positive patients (4.5%) were diagnosed with multiple infections. Main high-risk groups were patients who were <25 years old (for chlamydia), >25 years old (syphilis), men who have sex with men (MSM; for gonorrhoea/syphilis/HIV) or having symptoms (for any STI). Adherence to guideline-recommendations to test for multiple STI among high-risk groups varied from 15% to 75%. CONCLUSIONS This study found that characteristics of patients who consulted a GP for STIs were comparable to those of patients attending STI centres regarding age and ethnicity; however, consultations of high-risk groups like MSM and (clients of) commercial sex workers were reported less by the general practice. Where the STI centres routinely test all patients for chlamydia/syphilis/HIV/gonorrhoea, GPs tested more selectively, even more restricted than advised by GP guidelines. Test positivity was, therefore, higher in general practice, although it is unknown how many STIs are missed (particularly among high-risk groups). Opportunities for a more proactive role in STI/HIV testing at general practices in line with current guidelines should be explored.
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Affiliation(s)
- Suzan C M Trienekens
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Ingrid V F van den Broek
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Gé A Donker
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
| | - Jan E A M van Bergen
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
- STI AIDS Netherlands, Amsterdam, The Netherlands
- Faculty of Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Marianne A B van der Sande
- Epidemiology and Surveillance Unit, National Institute for Public Health and the Environment, Centre for Infectious Disease Control, Bilthoven, The Netherlands
- Julius Center, University of Utrecht, Utrecht, The Netherlands
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Schmid BV, Over EAB, van den Broek IVF, Op de Coul ELM, van Bergen JEAM, Fennema JSA, Götz HM, Hoebe CJPA, de Wit GA, van der Sande MAB, Kretzschmar MEE. Effects of population based screening for Chlamydia infections in the Netherlands limited by declining participation rates. PLoS One 2013; 8:e58674. [PMID: 23527005 PMCID: PMC3604006 DOI: 10.1371/journal.pone.0058674] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 02/05/2013] [Indexed: 12/31/2022] Open
Abstract
Background A large trial to investigate the effectiveness of population based screening for chlamydia infections was conducted in the Netherlands in 2008–2012. The trial was register based and consisted of four rounds of screening of women and men in the age groups 16–29 years in three regions in the Netherlands. Data were collected on participation rates and positivity rates per round. A modeling study was conducted to project screening effects for various screening strategies into the future. Methods and Findings We used a stochastic network simulation model incorporating partnership formation and dissolution, aging and a sexual life course perspective. Trends in baseline rates of chlamydia testing and treatment were used to describe the epidemiological situation before the start of the screening program. Data on participation rates was used to describe screening uptake in rural and urban areas. Simulations were used to project the effectiveness of screening on chlamydia prevalence for a time period of 10 years. In addition, we tested alternative screening strategies, such as including only women, targeting different age groups, and biennial screening. Screening reduced prevalence by about 1% in the first two screening rounds and leveled off after that. Extrapolating observed participation rates into the future indicated very low participation in the long run. Alternative strategies only marginally changed the effectiveness of screening. Higher participation rates as originally foreseen in the program would have succeeded in reducing chlamydia prevalence to very low levels in the long run. Conclusions Decreasing participation rates over time profoundly impact the effectiveness of population based screening for chlamydia infections. Using data from several consecutive rounds of screening in a simulation model enabled us to assess the future effectiveness of screening on prevalence. If participation rates cannot be kept at a sufficient level, the effectiveness of screening on prevalence will remain limited.
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Affiliation(s)
- Boris V. Schmid
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| | - Eelco A. B. Over
- Center for Nutrition, Prevention and Health Services, RIVM, Bilthoven, The Netherlands
| | | | | | - Jan E. A. M. van Bergen
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
- STI AIDS Netherlands, Amsterdam, The Netherlands
- Department of General Practice, Amsterdam Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | | | - Hannelore M. Götz
- Public Health Service Rotterdam Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christian J. P. A. Hoebe
- Public Health Service Southern Limburg, The Netherlands
- School of Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - G. Ardine de Wit
- Center for Nutrition, Prevention and Health Services, RIVM, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne A. B. van der Sande
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mirjam E. E. Kretzschmar
- Center for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
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Measuring the Uptake and Impact of Chlamydia Screening Programs—Easier Said Than Done. Sex Transm Dis 2012; 39:89-91. [DOI: 10.1097/olq.0b013e318245f95c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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