Volume 198 - Issue 2
Over 150 potentially low-value health care practices: an Australian study
Authors: Jane S Hocking, Basil Donovan and Rebecca Guy
Med J Aust 2013; 198 (2): 83-84. || doi: 10.5694/mja12.11741
Published online: 4 February 2013
Published online: 4 February 2013
To the Editor: Elshaug and colleagues identified chlamydia screening of under-25-year-olds in the general population as a potentially low-value health care practice.1 They cite a systematic review that found that evidence from randomised controlled trials (RCTs) on the impact of chlamydia screening on reducing pelvic inflammatory disease (PID) was limited to high-risk populations, had methodological limitations and had never involved repeated rounds of screening. However, ...
To the Editor: Elshaug and colleagues identified chlamydia screening of under-25-year-olds in the general population as a potentially low-value health care practice.1 They cite a systematic review that found that evidence from randomised controlled trials (RCTs) on the impact of chlamydia screening on reducing pelvic inflammatory disease (PID) was limited to high-risk populations, had methodological limitations and had never involved repeated rounds of screening.2 However, a recent RCT of a single round of screening, although underpowered to find a difference in PID incidence, did find that 9.5% of women with untreated chlamydia developed PID, compared with 1.6% of those who were treated (relative risk, 0.17; 95% CI, 0.17–1.01).3
In response to these uncertainties and in a world-first trial, the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) aims to determine whether repeated annual screening in general practice of women and men aged under 30 years will lead to a reduction in the prevalence of chlamydia infection and, potentially, PID incidence. This study involves the support of 150 general practice clinics in 52 geographical areas across four states. Baseline chlamydia prevalence in these mainly regional and rural clinics has been estimated to be about 5%; results of ACCEPt are due in 2015.
Given that Australia has one of the lowest screening rates in the developed world,4 the Royal Australian College of General Practitioners Guidelines for preventive activities in general practice recommends annual screening of young adults,5 notifications of chlamydia infection continue to rise relentlessly and comparable countries already have national chlamydia screening programs, it would seem premature to reduce screening before the results of ACCEPt become available.
Competing interests
We are all named investigators on a clinical trial of a chlamydia testing intervention in general practice funded by the Department of Health and Ageing and National Health and Medical Research Council. This trial is currently in progress.
References
- Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556-560. 0_CACCAJBB
- Low N, Bender N, Nartey L, et al. Effectiveness of chlamydia screening: systematic review. Int J Epidemiol 2009; 38: 435-448. 0_pgfId-2682860
- Oakeshott P, Kerry S, Aghaizu A, et al. Randomised controlled trial of screening for Chlamydia trachomatis to prevent pelvic inflammatory disease: the POPI (prevention of pelvic infection) trial. BMJ 2010; 340: c1642. 0_pgfId-2682869
- Kong FYS, Guy RJ, Hocking JS, et al. Australian general practitioner chlamydia testing rates among young people. Med J Aust 2011; 194: 249-252. 0_pgfId-2687199
- Guidelines for preventive activities in general practice. 8th ed. Melbourne: Royal Australian College of General Practitioners, 2012. 0_pgfId-2686514