D B Langille1, C T Naugler, M R Joffres. 1. Department of Community Health and Epidemiology, Faculty of Medicine at Dalhousie University in Halifax.
Abstract
OBJECTIVE: To determine family physicians' approaches to detecting, managing, and preventing genital Chlamydia trachomatis infection and their perceptions of barriers to prevention. To determine whether sex of physician is associated with differences in clinical approach to chlamydia, with levels of effort aimed at its prevention, and with perceived barriers to preventive efforts. DESIGN: Questionnaires were sent to a random sample of family physicians. SETTING: All health regions in Nova Scotia. PARTICIPANTS: Two hundred fifty-seven Nova Scotia family physicians. MAIN OUTCOME MEASURES: Responses to survey questions analyzed for association of practice behaviours with sex of physician. RESULTS: Response rate was 60%. Most physicians performed diagnostic tests for chlamydia on all patients. Responses indicated that 17% would test for C trachomatis during an annual Papanicolaou test in a low-risk 30-year-old, 61% would test a high-risk 21-year-old man, and 89% would test a pregnant 17-year-old. Therapies physicians might use were judged appropriate in 96% of responses. Only 51% indicated they would ever discuss false-positive test results with patients. Men physicians were less likely than women to ask 75% or more of their adolescent patients about sexual activity or to educate them about prevention of sexually transmitted diseases. Women physicians saw time and the fee schedule as less serious barriers to prevention than men did. CONCLUSIONS: Some physicians are not managing C trachomatis well. We should explore situations where gaps in performance are associated with sex of physician.
OBJECTIVE: To determine family physicians' approaches to detecting, managing, and preventing genital Chlamydia trachomatis infection and their perceptions of barriers to prevention. To determine whether sex of physician is associated with differences in clinical approach to chlamydia, with levels of effort aimed at its prevention, and with perceived barriers to preventive efforts. DESIGN: Questionnaires were sent to a random sample of family physicians. SETTING: All health regions in Nova Scotia. PARTICIPANTS: Two hundred fifty-seven Nova Scotia family physicians. MAIN OUTCOME MEASURES: Responses to survey questions analyzed for association of practice behaviours with sex of physician. RESULTS: Response rate was 60%. Most physicians performed diagnostic tests for chlamydia on all patients. Responses indicated that 17% would test for C trachomatis during an annual Papanicolaou test in a low-risk 30-year-old, 61% would test a high-risk 21-year-old man, and 89% would test a pregnant 17-year-old. Therapies physicians might use were judged appropriate in 96% of responses. Only 51% indicated they would ever discuss false-positive test results with patients. Men physicians were less likely than women to ask 75% or more of their adolescent patients about sexual activity or to educate them about prevention of sexually transmitted diseases. Women physicians saw time and the fee schedule as less serious barriers to prevention than men did. CONCLUSIONS: Some physicians are not managing C trachomatis well. We should explore situations where gaps in performance are associated with sex of physician.