PDF(Pubmed)
Abstract：
OBJECTIVE: Chlamydia trachomatis (chlamydia) is one of the most reported bacterial sexually transmitted infections (STI) worldwide. Chlamydia can cause long term complications such as pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI). Changing testing strategies, for example reduced asymptomatic testing, influence chlamydia surveillance, highlighting the need for exploring alternative ways of monitoring chlamydia. We investigated the possibility of introducing routine surveillance of chlamydia related long term complications.
METHODS: A qualitative study including 15 in-depth interviews with a purposive sample of gynaecologists, general practitioners (GP), sexual health and emergency doctors was conducted in the Netherlands in 2021-2022. A semi-structured interview guide focused on experiences with diagnosis and registration of PID, EP and TFI and how a change in asymptomatic chlamydia testing strategy might influence this. Interviews were transcribed and analysed using a thematic approach.
RESULTS: Analysis showed that gynaecologists most frequently reported diagnosing PID, EP and TFI. Other professions rarely diagnose these complications, with emergency doctors only diagnosing EP. Most respondents reported unique registration codes for PID and EP, but the coding for TFI is more ambiguous. They reflected that diagnosis and registration of PID, EP and TFI are handled differently within their professions. Most respondents acknowledged registration in diagnostic codes as a useful surveillance tool. They expressed concerns in representativeness (e.g. differences in interpretation of diagnosis criteria) and data quality for surveillance.
CONCLUSIONS: Patient files of gynaecologists are likely to be most complete for monitoring trends of diagnosed chlamydia related long term complications in the Netherlands. However, when establishing a chlamydia complication surveillance system, professionals should be engaged in further standardizing diagnosis and registration practices. This will improve the quality and interpretability of complication surveillance and facilitate comparison between countries.
METHODS: A qualitative study including 15 in-depth interviews with a purposive sample of gynaecologists, general practitioners (GP), sexual health and emergency doctors was conducted in the Netherlands in 2021-2022. A semi-structured interview guide focused on experiences with diagnosis and registration of PID, EP and TFI and how a change in asymptomatic chlamydia testing strategy might influence this. Interviews were transcribed and analysed using a thematic approach.
RESULTS: Analysis showed that gynaecologists most frequently reported diagnosing PID, EP and TFI. Other professions rarely diagnose these complications, with emergency doctors only diagnosing EP. Most respondents reported unique registration codes for PID and EP, but the coding for TFI is more ambiguous. They reflected that diagnosis and registration of PID, EP and TFI are handled differently within their professions. Most respondents acknowledged registration in diagnostic codes as a useful surveillance tool. They expressed concerns in representativeness (e.g. differences in interpretation of diagnosis criteria) and data quality for surveillance.
CONCLUSIONS: Patient files of gynaecologists are likely to be most complete for monitoring trends of diagnosed chlamydia related long term complications in the Netherlands. However, when establishing a chlamydia complication surveillance system, professionals should be engaged in further standardizing diagnosis and registration practices. This will improve the quality and interpretability of complication surveillance and facilitate comparison between countries.
摘要：
目的：沙眼衣原体（衣原体）是全球报道最多的细菌性性传播感染（STI）之一。衣原体可引起长期并发症，如盆腔炎（PID），异位妊娠（EP）和输卵管因素不孕症（TFI）。改变测试策略，例如减少无症状测试，影响衣原体监测，强调需要探索监测衣原体的替代方法。我们调查了对衣原体相关的长期并发症进行常规监测的可能性。
方法：一项定性研究，包括对有目的的妇科医生样本进行15次深入访谈，全科医生（GP），2021-2022年在荷兰开展了性健康和急诊医生。半结构化访谈指南，重点介绍PID的诊断和注册经验，EP和TFI以及无症状衣原体检测策略的变化可能会对此产生影响。使用专题方法对访谈进行转录和分析。
结果：分析表明，妇科医生最常报告诊断PID，EP和TFI。其他职业很少诊断这些并发症，急诊医生只诊断EP。大多数受访者报告了PID和EP的唯一注册码，但是TFI的编码更加模糊。它们反映了PID的诊断和注册，EP和TFI在其职业中的处理方式不同。大多数受访者承认在诊断代码中注册是一种有用的监视工具。他们对代表性（例如诊断标准解释的差异）和监测数据质量表示担忧。
结论：在荷兰，妇科医生的患者档案对于监测衣原体相关长期并发症的诊断趋势可能是最完整的。然而,当建立衣原体并发症监测系统时，专业人员应参与进一步规范诊断和注册实践。这将提高并发症监测的质量和可解释性，并促进国家之间的比较。
方法：一项定性研究，包括对有目的的妇科医生样本进行15次深入访谈，全科医生（GP），2021-2022年在荷兰开展了性健康和急诊医生。半结构化访谈指南，重点介绍PID的诊断和注册经验，EP和TFI以及无症状衣原体检测策略的变化可能会对此产生影响。使用专题方法对访谈进行转录和分析。
结果：分析表明，妇科医生最常报告诊断PID，EP和TFI。其他职业很少诊断这些并发症，急诊医生只诊断EP。大多数受访者报告了PID和EP的唯一注册码，但是TFI的编码更加模糊。它们反映了PID的诊断和注册，EP和TFI在其职业中的处理方式不同。大多数受访者承认在诊断代码中注册是一种有用的监视工具。他们对代表性（例如诊断标准解释的差异）和监测数据质量表示担忧。
结论：在荷兰，妇科医生的患者档案对于监测衣原体相关长期并发症的诊断趋势可能是最完整的。然而,当建立衣原体并发症监测系统时，专业人员应参与进一步规范诊断和注册实践。这将提高并发症监测的质量和可解释性，并促进国家之间的比较。
