A Critical Discussion About Delivery of Chlamydia Screening in Community Pharmacy

The purpose of this literature review is to discuss how effective the pharmacy delivers chlamydia screening in terms of training of staff, patients' perceptions and pharmacists' perceptions. Chlamydia trachomatis is an infection that can sexually transmits, and it has a greater impact on young people who are sexually active at age between 15-24 years old. According to Public Health England (2018), approximately 448,000 diagnoses of sexually transmitted infections (STIs) have been made and it has been enhanced by 5% since 2017.

Chlamydia screening is significant as it helps to prevent and reduce the negative consequences on patient’s health including pelvic inflammatory disease (PID) and infertility. Therefore, by allowing access to sexual health clinicals, GPs, community pharmacists and specialist genitourinary medicine services, they can provide testing and treatment for it.

While searching for resources to do the literature review, the database used such as MEDLINE, BioMed Central and Scopus. It has been restricted to Scholarly (peer reviewed) Journals and google scholar that have been published in UK and no older than 2006. The search terms that have been used like “Chlamydia Screening”,” Pharmacy services” and “Young people”. Furthermore, there was a book called “doing a literature review in health and social care” helped me to get an idea on how to write literature review.

This literature review will focus on how the community pharmacists deliver chlamydia screening and how to train staff more effectively in order to enhance quality of patient care. There will be using appropriate sources to analyse patients’ perception and pharmacists’ perception on these services. Hence, there will be reviewed about importance of pharmacy services and the impact of it in patient’s health. Finally, the issues that is associated with delivery of chlamydia screening and how to overcome these issues.

Community pharmacy has an important role in preventing and treatment of chlamydia disease. Ideally, pharmacists should offer chlamydia testing kits to any patients that needs it, but they have found it much easier to offer the test to patients who come to purchase Emergency Hormonal contraceptive (EHC), Condoms and if they asked about other sexual issues. Hence, it is important to provide advice on how to use the kits, how to return it and if the test result was positive how to treat it.

Chlamydia screening can be performed via NHS which is free for patients under 25 years old or it can be private so in this case patient needs to pay for screening kit. The price of the test kit is £25 and for the chlamydia treatment service is £18.99 in Boots pharmacy. After seven days, the patient would have received the test result directly via telephone call or letter. They can seek for treatment in community pharmacies which can treat the patient with single dose of antibiotic under patient group direction or in NHS clinics such as genitourinary medicine clinics.

Pharmacists encourage the patient who get positive test result to contact their current partner to do the test as STDs can be transmitted to a sex partner. The aim of this study was to provide “patient-delivered partner therapy”, so they provide a “pharmacy treatment voucher” to the patient’s partner in 90 pharmacists in Lothian, Scotland. During these 18 months of study, result shows that 40% of patients prefer to do the test in community pharmacy and pharmacists can treat the patient with single dose of antibiotic such as Azithromycin under patient group direction. It only 4% of the patients went to GUM clinics to receive treatment. This study was quite representative as it used large sample size for quite long time. And, it determines that most of the patients find it more convenient and accessible to do the test at community pharmacy, therefore by seeing the result we can get see that it reaches the patient’s satisfaction but it does not mean that it can replace traditional methods which was notify the partner and then refer them to the sexual clinics.

This is supported by Brugha R et al. (2011), who found that 76% of males and 77% of women preferred to offer chlamydia screening test by doctors or nurses and 90% of participants did not want to do the test in community pharmacy. Nearly all patients refused to do the test in non-healthcare setting. This was due to embarrassment talking about their sexual life and concerns about lack of pharmacists’ knowledge. This illustrates that it did not reach the high quality of care so by reassuring the member of public that pharmacy staff have capacity and knowledge to do the test so they can trust them. Hence, we can gain more positive patient perception on pharmacy services and then eventually, have a greater impact on the outcome of other patients that receive the service.

The research was done in 3 community pharmacies in south east London and the duration of research was for 3 months. They have used different methods such as questionnaires and interviews .80 questionnaires were completed by patients after the consultation and 24 were interviewed. The result shows that 73 of questionnaires were completed by women and only 5 by men. Overall, the patients found it more convenience and accessible to do the test at community pharmacy and there is no need to book an appointment in advance so the patient can access to it at any time. This study is not good representative as it has only used small size of sample compare to the pharmacists in the Uk. Hence, most of the questionnaires were filled with women and men’s view was restricted and they haven't used a uniform method as they used questionnaire and interviews. 

The aim of these two above studies was to see if it was acceptable to do the chlamydia screening and its treatment at community pharmacy. We can see that there is contrast between these two studies and first study is better representative as it used larger sample size compare to the second study.

The pharmacist’s perceptions are as important as patient’s perceptions so this is supported by Brabin L et al. (2009), it determines to offer the chlamydia screening to women who are under 25 year that come to the pharmacy to purchase an Emergency Hormone Contraception (EHC) which was offered in 33 pharmacies in Manchester. The result shows that number of women that were given EHC was 2718 but only 675 (24.8%) were offered a chlamydia kit. Based on the tracking form that pharmacists provided during the study shows that 46.4% who have accepted the kit but only 17.6% of them returned the sample to laboratory and then 9.1% of them were chlamydia positive. This study was restricted to women who were purchasing EHC therefore it’s not good representative as it conducted males view. The result determines that pharmacists did not offer the test to every single client that came to the pharmacy, this can be due to the lack of training on how to approach a patient. We need to provide additional sexual health training to a member of pharmacy staff and hence improve their communication skills to be able to approach patient more confident. 

166 of community pharmacies, which is located in Lothian, Scotland, were received the self-reported questionnaires in April 2009. It is significant to evaluate capability and training requires for pharmacists and pharmacy staff in order to delivery of chlamydia screening in high standard. The results of this study determine that for achieving successful result for chlamydia screening pharmacists, technicians and counter assistants require additional training. One of the ways to provide training is role-play exercise which was useful in assess of the training of pharmacies for providing Emergency Hormone Contraception (EMC). They could have distance learning about chlamydia trachomatis symptoms and the process of its treatment. This study identifies that enhancing the knowledge of pharmacy staff, especially counter assistances as they are the first person that comes in contact with clients, helps them enhances their confidence and increases client’s contentment.

Currently, only a small proportion of community pharmacists offer chlamydia screening so this article which is supported by Dabreea,G et al (2010) is about understanding barriers that community pharmacists face in offering chlamydia screening. This study looks in 10 pharmacies in London, one of the main barriers that they have found was so difficult to offer the test to the patients with non-sexual health related services and young people between 15-17 years.

The aim of this study was to investigate knowledge and awareness of young people about Chlamydia trachomatis using self-report questionnaire regarding health and fitness, workplace and colleges in Scotland. 363 questionnaires were completed the result shows there was lack of knowledge about chlamydia trachomatis. This study was quite representative as it used a large sample size of populations, but it was only restricted to young people. However, it used different locations to do the test which increasing response rate and trustworthiness of the test.

These two above studies identified that there is lack of training for pharmacists’ staff and lack of education and awareness in young people. It is important to build up a good relationship between patients and pharmacists in order to improve the quality of patients care and enhance patients' satisfactions. Therefore, to overcome these barriers they have decided to put information leaflet in customers' bags, display posters at community pharmacies and educate young children at school in order to provide knowledge and advice on how to have healthy relationship. Hence, there is some work needs to be done in order to convert scientific language to non-scientific language so by doing this it will helps to improve public’s knowledge about chlamydia trachomatis.