PUBH 8502 Week 11 Review Draft Example

Organized Around the Manager's Choice, With Its Gaps Named Early: A Practice Review Draft on Raising Three-Month Chlamydia Retest Rates at a Composite Walk-In Clinic

Student Name

Walden University

PUBH 8502: Scholar-Practitioner Inquiry II

Instructor Name

Month Day, Year

Organized Around the Manager's Choice, With Its Gaps Named Early: A Practice Review Draft on Raising Three-Month Chlamydia Retest Rates at a Composite Walk-In Clinic

Summary

Harbor Street, an invented public walk-in sexual health clinic, retests well under half of the clients it treats for chlamydia within four months, although the national schedule calls for retesting roughly three months on (Workowski et al., 2021). This review asked which changes to follow-up have raised retest rates in comparable clinics. Its recommendation is a twelve-month local trial with two arms. Every treated client would have phone and address checked before leaving and would get a text, then a call, when the retest falls due; residents of the clinic's two eastern neighborhoods would also be offered a self-collection kit by mail. Incentive payments are not recommended.

Methods

The question asked whether, among people treated for chlamydia at outpatient or sexual health clinics, any change to follow-up, compared with usual advice, increased the proportion who had a retest within roughly three to six months. Three databases were searched from 2000 onward (PubMed, CINAHL and the Cochrane Library), with the first 200 Google Scholar results checked for missed reports. The PubMed string combined chlamydia terms with retest, rescreening, reminder, text messaging, home testing and mailed kit terms; full strings for every database are given in the appendix. The search was piloted against three known studies and revised until all three were retrieved, following a stepwise approach to search development (Bramer et al., 2018).

Seven inclusion rules were fixed before screening. They required a clinic population treated for chlamydia, any intervention aimed at retesting, a concurrent or historical comparison, a retest outcome with a clear denominator, a controlled design, a high-income setting, and a full report from 2000 onward. Two readers screened titles and abstracts independently and resolved disagreements by discussion. Each included study was appraised with the CASP questions and judged separately for applicability and transferability to Harbor Street (Wang et al., 2005).

Limitations

The review is a practice review, not a systematic review. It searched three databases and did not hand-search journals or contact authors. Conference abstracts were excluded, so recent unpublished trials may be missing. Only one included study was randomized; the others used historical or nonrandomized comparisons, which tend to exaggerate effects. Outcome windows ranged from three to eight months, so retest rates were not measured on the same clock. No included study took place at a walk-in clinic similar to Harbor Street, and none measured whether higher retesting reduced complications.

Findings by Decision

Should Harbor Street Use Reminders?

Reminders are the most studied change. In a randomized comparison at public STD clinics, a phone reminder at three months raised return compared with a brief recommendation, though the estimate was imprecise (Malotte et al., 2004). A reminder postcard at one New York City clinic was followed by more retesting than at clinics without it (Paneth-Pollak et al., 2010). A text reminder at six months in the Netherlands was followed by 30.6% returning, where a historical comparison group had returned at 9.2% (Kampman et al., 2015). A systematic review found reminders promising but too varied in effect to pool (Guy et al., 2012).

Applicability is high: the clinic already calls clients and can send texts. Transferability is uncertain. Harbor Street's observation log found many reminders failed because phone numbers had changed by three months, and the contradiction analysis suggested that delivery failure can erase a reminder's effect. Reminders are therefore recommended only alongside confirmed contact details.

Should Harbor Street Offer Mailed Kits?

At a regional Australian clinic, 34.8% of clients offered a mailed self-collection kit returned a sample within three to four months, compared with 6.8% of a historical control group and 1.4% of concurrent controls (Buhrer-Skinner et al., 2011). The intervention group was small, so the estimate is imprecise. Across controlled trials in the systematic review, mailed kits had a modest but consistent positive effect (Guy et al., 2012).

Applicability is moderate: kits need money for postage and stock, plus a laboratory willing to process samples that arrive by mail. Transferability is likely highest for clients who face long trips. Harbor Street's distribution analysis found that residents of two eastern neighborhoods, beyond the end of the bus line, carry more of the retest gap than their numbers predict. A kit removes the trip, which no reminder can do.

Should Harbor Street Pay Incentives?

Paying clients $20 when they came back produced no clear gain over simply advising them to return (Malotte et al., 2004). Incentives are not recommended.

How Settled the Evidence Is

Settled: retesting is uncommon across settings, reaching only a minority of treated men and women in national laboratory data (Hoover et al., 2012), and active follow-up raises it. Disputed: how much reminders help, and whether incentives help at all. Untried: reminders combined with contact confirmation, kits targeted by distance, and any intervention at a walk-in clinic.

Should Harbor Street Confirm Contact Details?

No included study tested this step directly, but it follows from the evidence. Every reminder study depends on reaching the client, and Harbor Street's own records show that reaching clients is where follow-up most often fails. Confirming a phone number and asking for a second contact method takes about a minute at the treatment visit and costs nothing beyond staff time. It is recommended as the foundation for any reminder, not as an intervention in its own right.

What a Local Trial Would Add

Because the most relevant questions are untried, a local trial at Harbor Street would add knowledge, not just confirm it. The trial should measure retesting within four months drawing on statewide laboratory reports matched to clinic clients, which credits tests done at other sites, and should report results separately for walk-in clients and for the two eastern neighborhoods.

Recommendation

Begin the two-arm trial described in the summary when the clinic's next budget year opens. Measure both against the clinic's matched retest rate from the year before. Review results at six months and stop either part if it shows no gain by the end of the year. Report the trial's results back to staff, who will run both arms, and to the state STI program, whose matched records make the measurement possible. If either arm works, the clinic will have produced the first evidence on that change in a walk-in setting, which is itself a reason to write it up for others facing the same gap.

References

Bramer, W. M., De Jonge, G. B., Rethlefsen, M. L., Mast, F., & Kleijnen, J. (2018). A systematic approach to searching: An efficient and complete method to develop literature searches. Journal of the Medical Library Association, 106(4), 531-541. https://doi.org/10.5195/jmla.2018.283

Buhrer-Skinner, M., Muller, R., Buettner, P. G., Gordon, R., & Debattista, J. (2011). Improving Chlamydia trachomatis retesting rates by mailed self-collection kit. Sexual Health, 8(2), 248-250. https://doi.org/10.1071/SH10064

Guy, R., Hocking, J., Low, N., Ali, H., Bauer, H. M., Walker, J., Klausner, J. D., Donovan, B., & Kaldor, J. M. (2012). Interventions to increase rescreening for repeat chlamydial infection. Sexually Transmitted Diseases, 39(2), 136-146. https://doi.org/10.1097/OLQ.0b013e31823ed4ec

Hoover, K. W., Tao, G., Nye, M. B., & Body, B. A. (2012). Suboptimal adherence to repeat testing recommendations for men and women with positive chlamydia tests in the United States, 2008-2010. Clinical Infectious Diseases, 56(1), 51-57. https://doi.org/10.1093/cid/cis771

Kampman, C. J. G., Koedijk, F. D. H., Driessen-Hulshof, H. C. M., Hautvast, J. L. A., & van den Broek, I. V. F. (2015). Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: A prospective study with historical controls. Sexually Transmitted Infections, 92(2), 124-129. https://doi.org/10.1136/sextrans-2015-052115

Malotte, C. K., Ledsky, R., Hogben, M., Larro, M., Middlestadt, S., St. Lawrence, J. S., Olthoff, G., Settlage, R. H., & Van Devanter, N. L. (2004). Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics. Sexually Transmitted Diseases, 31(11), 637-642. https://doi.org/10.1097/01.olq.0000143083.38684.9d

Paneth-Pollak, R., Klingler, E. J., Blank, S., & Schillinger, J. A. (2010). The elephant never forgets: Piloting a chlamydia and gonorrhea retesting reminder postcard in an STD clinic setting. Sexually Transmitted Diseases, 37(6), 365-368. https://doi.org/10.1097/OLQ.0b013e3181cab281

Wang, S., Moss, J. R., & Hiller, J. E. (2005). Applicability and transferability of interventions in evidence-based public health. Health Promotion International, 21(1), 76-83. https://doi.org/10.1093/heapro/dai025

Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Park, I., Reno, H., Zenilman, J. M., & Bolan, G. A. (2021). Sexually transmitted infections treatment guidelines, 2021. MMWR Recommendations and Reports, 70(4), 1-187. https://doi.org/10.15585/mmwr.rr7004a1