***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Primary care clinicians suggest that staff education is needed to increase chlamydia testing appropriately . OBJECTIVES To determine if interactive workshops and modified laboratory request forms could increase testing and case detection . METHODS STUDY DESIGN Prospect i ve cluster r and omized controlled study , using modified Zelen 's design , examining the effect of workshops and modified request forms on primary care clinicians ' chlamydia specimen su bmi ssion and case positivity rate . STUDY POPULATION 82 general practice s in six geographical clusters within five primary care trusts ( PCTs ) in Gloucestershire and County Durham and Darlington . INTERVENTION Practice s within geographical clusters were r and omly assigned to workshops on chlamydia or a control consisting of comparable workshops on the management of urinary symptoms , held in PCT-protected learning time . Half the practice s were r and omized to receive modified laboratory request forms . Staff were unaware that they were part of a study . RESULTS Interactive workshops  increased chlamydia testing in 16- to 24-year-old women by 33 % in intervention practice s compared to controls with effect persisting at 10 months ( P = 0.003 ) . No associated rise in the number of chlamydia infections was detected ( P = 0.91 ) , suggesting that increased testing may have occurred in a lower risk population . Modified forms did not change test su bmi ssion ( P = 0.75 ) . CONCLUSIONS Interactive workshops for general practice s can be used to successfully increase chlamydia-testing rates . Chlamydia detection rates will need to be monitored as this type of educational programme may not increase absolute numbers of chlamydia infections detected , if patients at lower risk of infection are inappropriately tested . Other interventions may need to be combined with the workshops , to reach sufficiently high chlamydia screening rates to significantly reduce prevalence of chlamydial infection OBJECTIVE To determine whether asking general practitioners to offer chlamydia screening at the same time as Pap screening increases chlamydia screening rates . DESIGN A pragmatic cluster r and omised controlled trial . PARTICIPANTS AND SETTING Doctors from 31 general practice s in the Australian Capital Territory performing more than 15 Pap smear screens per year , and all women aged 16 - 39 years attending those practitioners between 1 November 2004 and 31 October 2005 . INTERVENTION Doctors in the intervention practice s were asked to routinely offer combined chlamydia and Pap screening to eligible women ; doctors in the control practice s  were asked to implement screening guidelines based on a risk assessment of the individual patient ( ie , usual practice ) . MAIN OUTCOME MEASURE Chlamydia screening rate per visit . RESULTS There were 26 876 visits by eligible women during the study period : 16 082 to intervention practice s and 10 794 to control practice s.  Chlamydia screening occurred during 6.9 % ( 95 % CI , 6.5%-7.3 % ) of visits to intervention practice s and 4.5 % ( 95 % CI , 4.1%-4.9 % ) of visits to control practice s. After controlling for clustering and potential confounders , there were twofold greater odds of chlamydia screening occurring during a visit by an eligible woman to an intervention practice than to a control practice ( adjusted odds ratio , 2.1 [ 95 % CI , 1.3 - 3.4 ] ) . CONCLUSION Combining chlamydia and Pap screening increases the rate of chlamydia screening in general practice . Implementing this approach would require little additional infrastructure support in setting s where a cervical screening program already exists Background Financial incentives have been used for many years internationally to improve quality of care in general practice . The aim of this pilot study was to determine if offering general practitioners ( GP ) a small incentive payment per test would increase  chlamydia testing in women aged 16 to 24 years , attending general practice . Methods General practice clinics ( n = 12 ) across Victoria , Australia , were cluster r and omized to receive either a $ AUD5 payment per chlamydia test or no payment for testing 16 to 24 year old women for chlamydia . Data were collected on the number of chlamydia tests and patient consultations undertaken by each GP over two time periods : 12 month pre-trial and 6 month trial period . The impact of the intervention was assessed using a mixed effects logistic regression model , accommodating for clustering at GP level . Results Testing increased from 6.2 % ( 95 % CI : 4.2 , 8.4 ) to 8.8 % ( 95 % CI : 4.8 , 13.0 ) ( p = 0.1 ) in the control group and from 11.5 % ( 95 % CI : 4.6 , 18.5 ) to 13.4 % ( 95 % CI : 9.5 , 17.5 ) ( p = 0.4 ) in the intervention group . Overall , the intervention did not result in a significant increase in chlamydia testing in general practice . The odds ratio for an increase in testing in the intervention group compared to the control group was 0.9 ( 95 % CI : 0.6 , 1.2 ) . Major barriers to increased chlamydia testing reported by GPs included a lack of time , difficulty in remembering to offer testing and a lack of patient awareness around testing . Conclusions A small financial incentive alone did not increase chlamydia testing  among young women attending general practice . It is possible small incentive payments in conjunction with reminder and feedback systems may be effective , as may higher financial incentive payments . Further research is required to determine if financial incentives can increase testing in Australian general practice , the type and level of financial scheme required and whether incentives needs to be part of a multi-faceted package . Trial Registration Australian New Zeal and Clinical Trial Registry ACTRN12608000499381 BACKGROUND Opportunistic testing and screening for genital chlamydia infection in sexually active women under the age of 25 years can lead to a reduction in chlamydia infection and its related morbidity . AIMS To explore the barriers to testing for genital chlamydial infection in primary care . DESIGN OF STUDY Qualitative study with focus groups . SETTING Rural and urban general practice in Southwest Engl and . METHODS Focus groups were held with r and omly selected high- and lowtesting general practice s in Herefordshire , Gloucestershire and Avon . The high- and low-testing practice s did not differ in their age/sex make-up , or by deprivation indices . Open questions were asked about the management of genitourinary symptoms and opportunistic testing for chlamydia . Data were collected and analysed concurrently until saturation occurred . RESULTS Although staff from high test rate practice s were much more aware of the evidence for opportunistic chlamydia testing and screening , none of the practice s were happy to discuss chlamydia in a consultation unrelated to sexual health . The greatest barriers to opportunistic chlamydia testing and screening were lack of knowledge of the benefits of testing , when and how to take specimens , lack of time , worries about discussing sexual health , and lack of guidance . Healthcare staff stated that any increased testing should be accompanied by clear , concise primary care trust guidance on when and how to test , including how to obtain informed consent and perform contact tracing . Staff felt that testing could be undertaken at family planning clinics or with cervical smears if patients received information before the consultation . Alternatively , in larger practice s specific chlamydia clinics could be held . CONCLUSION The Department of Health needs to be aware of the extreme pressures that primary care staff are under , and the potential barriers to any screening implementation . Efforts to increase chlamydia screening in this setting should be accompanied by clear guidance and education . Any chlamydia clinics or increased testing must have appropriate financial and staff re sources . Genitourinary medicine ( GUM ) clinics , or level three practice s with GUM expertise , will need to be increased in parallel with testing in primary care to provide appropriate contact tracing and follow-up CONTEXT Chlamydia trachomatis infection is a serious public health concern that disproportionately affects adolescent girls . Although annual C trachomatis screening of sexually active adolescent girls is recommended by health professional organizations and is a Health Employer Data and Information Set ( HEDIS ) performance measure , this goal is not being met . OBJECTIVE To test the effectiveness of a system-level , clinical practice improvement intervention design ed to increase C trachomatis screening by using urine-based tests for sexually active adolescent girls identified during their routine checkups at a pediatric clinic . DESIGN , SETTING , AND PARTICIPANTS A r and omized cluster of 10 pediatric clinics in the Kaiser Permanente of Northern California health maintenance organization , where adolescent girls aged 14 to 18 years had a total of 7920 routine checkup visits from April 2000 through March 2002 . INTERVENTION Five clinics were r and omly assigned to provide usual care and 5 to provide the intervention , which required that leadership be engaged by showing the gap between best practice and current practice ; a team be assembled to champion the project ; barriers be identified and solutions developed through monthly meetings ; and progress be monitored with site-specific screening proportions . MAIN OUTCOME MEASURE Chlamydia trachomatis screening rate for sexually active 14- to 18-year-old girls during routine checkups at each participating clinic . RESULTS The population of adolescents was ethnically diverse with an average age of 15.4 years . Twenty-four percent of girls in the experimental clinics and 23 % in the control clinics were sexually active . Of the 1017 patients eligible for screening in the intervention clinic , 478 ( 47 % ) were screened ; of 1194 eligible for screening in the control clinic , 203 ( 17 % ) were screened . At baseline , the proportion screened was 0.05 ( 95 % confidence interval [ CI ] , 0.00 - 0.17 ) in the intervention and 0.14 ( 95 % CI , 0.01 - 0.26 ) in the control clinics . By months 16 to 18 , screening rates were 0.65 ( 95 % CI , 0.53 - 0.77 ) in the intervention and 0.21 ( 95 % CI , 0.09 - 0.33 ) in the control clinics ( time period by study group interaction , F(6,60 ) = 5.33 ; P<.001 ) . The average infection rate for the experimental clinics was 5.8 % ( 23 positive test results out of 393 total urine tests and a total of 3986 clinic visits ) vs 7.6 % in controls ( 12 positive test results out of 157 tests and 3934 clinic visits ) . CONCLUSIONS Implementation of this clinical practice intervention in a large health maintenance organization system is feasible , and it significantly increased the C trachomatis screening rates for sexually active adolescent girls during routine checkups OBJECTIVES We sought to determine the effectiveness of a systems-based intervention design ed to increase  Chlamydia trachomatis ( CT ) screening  among adolescent boys . METHODS An intervention aim ed at increasing  CT screening  among adolescent girls was extended to adolescent boys ( 14 - 18 years ) . Ten pediatric clinics in a health maintenance organization with an ethnically diverse population were r and omized . Experimental clinics participated in a clinical practice improvement intervention ; control clinics received traditional information on screening . RESULTS The intervention significantly increased CT screening at the experimental sites from 0 % ( baseline ) to 60 % ( 18-month posttest ) ; control sites evidence d a change only from 0 % to 5 % . The overall prevalence of CT was 4 % . CONCLUSIONS Although routine CT screening is currently recommended only for young sexually active women , the present results show that screening interventions can be successful in the case of adolescent boys , among whom CT is a moderate problem Background : Chlamydia notifications are increasing in Australia , and the use of a computer alert prompting general practitioners to test young women is a potential way to increase opportunistic chlamydia testing . The aim of this trial was to determine the effectiveness of a computer alert in general practice on chlamydia testing in young women . Methods : In 2006 , clinics ( n = 68 ) in Melbourne , Australia were cluster r and omized into 2 groups : the intervention group received a computerized alert advising the general practitioner to discuss chlamydia testing with their patient which popped up when the medical record of a 16- to 24-year-old woman was opened ; the control group received no alert . The outcome was whether or not that patient received a chlamydia test at the level of a single consultation with an eligible patient . A mixed effects logistic regression model adjusting for clustering was used to assess the impact of the alert on the proportion of women tested for chlamydia during the trial period . Results : Testing increased from 8.3 % ( 95 % confidence interval ( CI ) : 6.8 , 9.8 ) to 12.2 % ( 95 % CI : 9.1 , 15.3 ) ( P < 0.01 ) in the intervention group , and from 8.8 % ( 95 % CI : 6.8 , 10.7 ) to 10.6 % ( 95 % CI : 8.5 , 12.7 ) ( P < 0.01 ) in the control group . Overall , the intervention group had a 27 % ( OR = 1.3 ; 95 % CI : 1.1 , 1.4 ) greater increase in testing . Conclusion : The results of this study suggest that alerts alone may not be sufficient to get ch 
    Output:
    
Conclusions Interventions that promoted the universal offer of a chlamydia test in young people had the greatest impact on increasing screening in primary care