Missed opportunities - Low levels of chlamydia retesting at Australian general practices, 2008-2009

Objective: Chlamydia reinfection is common and increases the risk of reproductive complications. Guidelines for Australian general practitioners recommend retesting 3-12 months after a positive result but not before 6 weeks. The authors describe retesting rates among 16-29-year-old patients diagnosed as having chlamydia at 25 general practice clinics participating in the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance system. Methods: The authors calculated annual testing and positivity rates for 16-29-year-olds attending in 2008-2009, re-attendance and retesting rates within <6 weeks, 1.5-4 months and 1.5-12 months of a positive test in 2008-2009 and positivity at retest (where results were available). Results: There were 50 408 individuals (60.4% women) who attended in 2008-2009. Annually, 7.4% and 7.3% were tested for chlamydia, of whom 9.1% and 8.0% tested positive, respectively. Within 1.5-4 months of a positive test, 24.6% re-attended and were retested (19% tested positive), 31.6% re-attended and were not retested and 43.9% did not re-attend. Within 1.5-12 months, 40% re-attended and were retested (16% tested positive), 40% re-attended and were not retested and 20% did not re-attend. Of individuals re-attending in 1.5-12 months but not retested, 50% had re-attended three or more times in the period. Within 6 weeks of a positive test, 25% were retested. Discussion: A high proportion of 16-29-year-olds re-attended general practices in the recommended retest periods, but retesting rates were low and multiple missed opportunities were common. The findings highlight the need for strategies such as electronic clinician prompts, patient recall systems and promotion of retesting guidelines.