Self‐reported health,healthcare service use and health‐related needs: A comparison of older and younger homeless people

The number of older homeless people with a limited life expectancy is increasing. European studies on their health‐related characteristics are lacking. This study compared self‐reported health, healthcare service use and health‐related needs of older and younger homeless people in the Netherlands. It is part of a cohort study that followed 513 homeless people in the four major Dutch cities for a period of 2.5 years, starting from the moment they registered at the social relief system in 2011. Using cross‐sectional data from 378 participants who completed 2.5‐year follow‐up, we analysed differences in self‐reported health, healthcare service use, and health‐related needs between homeless adults aged ≥50 years (N = 97) and <50 years (N = 281) by means of logistic regression. Results show that statistically significantly more older than younger homeless people reported cardiovascular diseases (23.7% versus 10.3%), visual problems (26.8% versus 14.6%), limited social support from family (33.0% versus 19.6%) and friends or acquaintances (27.8% versus 14.6%), and medical hospital care use in the past year (50.5% versus 34.5%). Older homeless people statistically significantly less often reported cannabis (12.4% versus 45.2%) and excessive alcohol (16.5% versus 27.0%) use in the past month and dental (20.6% versus 46.6%) and mental (16.5% versus 25.6%) healthcare use in the past year. In both age groups, few people reported unmet health‐related needs. In conclusion, compared to younger homeless adults, older homeless adults report fewer substance use problems, but a similar number of dental and mental problems, and more physical and social problems. The multiple health problems experienced by both age groups are not always expressed as needs or addressed by healthcare services. Older homeless people seem to use more medical hospital care and less non‐acute, preventive healthcare than younger homeless people. This vulnerable group might benefit from shelter‐based or community outreach programmes that proactively provide multidisciplinary healthcare services.     

Personal goals and factors related to QoL in Dutch homeless people: what is the role of goal‐related self‐efficacy?

Very little is known about the personal goals of homeless people and how these relate to their quality of life (QoL). By using survey data on 407 homeless adults upon entry to the social relief system in 2011, we examined the personal goals of homeless adults and the association between their perceived goal‐related self‐efficacy and their QoL. A hierarchical regression analysis was used to analyse the association between QoL and goal‐related self‐efficacy, relative to factors contributing to QoL, such as demographic characteristics, socioeconomic resources, health and service use. Results indicate that the majority of homeless adults had at least one personal goal for the coming 6 months and that most goals concerned housing and daily life (94.3%) and finances (83.6%). The QoL of homeless adults appeared to be lower in comparison with general population samples. General goal‐related self‐efficacy was positively related to QoL (β = 0.09, P = 0.042), independent of socioeconomic resources (i.e. income and housing), health and service use. The strongest predictors of QoL were psychological distress (β = ?0.45, P < 0.001), income (β = 0.14, P = 0.002) and being institutionalised (β = 0.12, P = 0.004). In conclusion, the majority of homeless adults entering the social relief system have personal goals regarding socioeconomic resources and their goal‐related self‐efficacy is positively related to QoL. It is therefore important to take the personal goals of homeless people as the starting point of integrated service programmes and to promote their goal‐related self‐efficacy by strength‐based interventions.     

The healthcare experiences of Koreans living in North Carolina: a mixed methods study

This study examined the healthcare experiences of Korean immigrants aged 40–64 living in the North Carolina Triangle area of the Southeastern United States. Using a mixed methods design, we collected quantitative data via a questionnaire from 125 participants and conducted a focus group with 10 interviewees from December 2010 to February 2011. The quantitative data were analysed using t‐tests and chi‐square tests, and a thematic analysis was used for the focus group study. Questionnaire findings showed that only 27.2% had sufficient English skills to communicate adequately. Participants with insurance were significantly more likely to be employed (P < 0.001), had higher incomes (P = 0.011) and higher education (P < 0.001), and had greater English‐speaking ability (P = 0.011) than those without insurance. Participants who did not use healthcare services showed significantly less knowledge (P < 0.001) of and less satisfaction (P = 0.034) with the healthcare system than those using healthcare services. Sixty‐two participants (49.6%) reported having no health insurance for one or more of the following reasons: high costs (75.8%), medical tourism (22.6%) and lack of information or knowledge (6.5%). The following themes emerged from the data collected during the focus group: (i) barriers to utilisation of healthcare services; (ii) facilitators of utilisation of healthcare services; and (iii) social support seeking for health management. Our mixed methods study findings indicate that healthcare disparities exist among Korean immigrants and that a number of factors, including health literacy, may contribute to their poor health outcomes. Continued collaboration among community members, healthcare professionals and academicians is needed to discuss the community's health concerns and to develop sustainable programmes that will ensure meaningful access to care for those with limited English proficiency and medically underserved populations.     

Australian homeless persons’ experiences of social connectedness,isolation and loneliness

Both loneliness and a lack of social integration are associated with serious physical and psychological health issues. One population highly susceptible to social isolation and loneliness are individuals who are homeless, who also experience high rates of mental disorder and relationship breakdown. Despite this, little research has explored how social networks, isolation and loneliness are experienced for those with a history of homelessness. In‐depth, semi‐structured interviews were used to get a nuanced understanding of how social networks and isolation are experienced and understood by individuals experiencing homelessness. Sixteen participants who were either homeless (n = 11) or previously homeless (n = 5) in Sydney, Australia, completed one‐off interviews that were audio‐recorded and transcribed. Data were analysed using thematic analysis. Participants constructed their social networks as being both constrained and enabled by marginalisation. They experienced rejection from the non‐homeless: the loss of critical network members, including rejection from family and a lack of companionship, and low quality and precarious relationships within the homeless community. These accounts were best conceptualised through loneliness theory. Participant's accounts signal that the homeless will likely continue feeling isolated if mainstream attitudes towards homelessness remain stigmatising and discriminatory.     

Vitamin supplementation and nutritional status in homeless men

Abstract: Homeless men and women are both physically and socially disadvantaged. Their nutritional status is also often compromised. In this sample of 107 homeless men in Sydney, about half reported taking vitamin supplements (with varying duration and regularity), usually a regimen consisting of thiamin, vitamin C, folic acid and a multivitamin–B–complex capsule. In this cross-sectional study, little effect could be seen on clinical health between those reporting taking vitamin supplementation and those not doing so. However, biochemical measurements showed significant differences. The numbers of men classified as deficient were higher by about 20 per cent for those reporting not taking vitamins. The mean biochemical levels were significantly better for the supplemented group for thiamin, as assessed by TPP per cent effect (P = 0.04), vitamin B6, as assessed by P5′P per cent effect (P = 0.002), vitamin C (P < 0.001) and blood folate (P < 0.02). Consequently, on the basis of mean biochemical levels of vitamin status, the supplemented group were better off and it is reasonable to presume that in the long term this would be reflected in improved clinical status.     

Metabolic syndrome is associated with impaired health-related quality of life: Lapinlahti 2005 study

Purpose  Association of Metabolic Syndrome (MetS) with Health-Related Quality of Life (HRQoL) is poorly documented. Our objective was to examine this association in an adult general population. Methods  In our cross-sectional community-based health survey in a semirural Finnish community, we invited all the adults (n = 760) of eight birth cohorts between 30 and 65 years, of which 480 (63%) participated. A 15-dimensional, standardized HRQoL instrument (15D) was used to measure the main outcome, and the National Cholesterol Education Programme (NCEP) 2005 criteria were used for MetS classification. Results  The prevalence of MetS was 38%. MetS was significantly associated with impaired HRQoL (P < 0.001) measured by the 15D score. Participants with MetS were statistically significantly worse off than participants without MetS in the dimensions of mobility (P < 0.001), hearing (P = 0.021), breathing (P < 0.001), usual activities (P = 0.001), discomfort and symptoms (P = 0.002), vitality (P = 0.003), and sexual activity (P = 0.008). In a logistic regression analysis, a significant association persisted between MetS and impaired HRQoL (OR = 1.9). Conclusions  MetS seems to be associated closely with perceived HRQoL at community level. Therefore, reduction of risk factors of MetS may improve HRQoL.     

The effects of depression and chronic diseases on the work outcomes of employees: a prospective study in Northwest China

A prospective cohort study was conducted to examine the impact of physical and mental health status on the job loss and job turnover rates in Northwestern China. There were 1778 employees included in the baseline survey at April 2006 and were followed-up in October 2006. They were classified into four groups: those with chronic diseases (n = 205), depression (n = 273), both chronic diseases and depression (n = 96), and a control group (n = 1204). Logistic regression was used to examine the impact of depression and chronic diseases on employment between the baseline and the 6-month follow-up interviews. The results of the analyses showed that participants suffering from depression were more likely to be unemployed (OR, 1.44; P < 0.05), recently changed jobs (OR, 3.28, P < 0.001) and earning a lower salary (B = −135.28RMB, P < 0.001). Depression accompanying chronic diseases had an increased risk of unemployment (OR, 2.05; P < 0.01). The participants with chronic diseases were more likely to change their jobs (OR, 2.53; P < 0.05), but this had no significant impact on unemployment and monthly salary. Overall, the findings suggest that people with depression were at a higher risk of unemployment and job turnover than people with chronic disease.     

Initial findings: primary diabetes care responsibility among emerging adults with type 1 diabetes post high school and move out of parental home

Background Emerging adults with diabetes are assuming diabetes care responsibility, graduating from high school and leaving their parental homes. We examined: (1) how diabetes care responsibility changed in relation to time (high school to post high school) and living situation (living independently or not of parents) and (2) the association of diabetes self‐efficacy, worry about hypoglycaemia, gender and glycaemic control with these changes in responsibility among emerging adults with type 1 diabetes. Methods During the last 6 months in high school (T1), 113 participants completed diabetes care responsibility (total, daily and non‐daily), diabetes self‐efficacy and worry about hypoglycaemia scales. Participants again completed the responsibility scales post high school graduation (T2). We used a linear mixed‐effects model with diabetes self‐efficacy, worry about hypoglycaemia, time since graduation, living situation, gender and glycaemic control as independent variables; and diabetes care responsibility (total, daily and non‐daily) as dependent variables. Moderation involving diabetes self‐efficacy, worry about hypoglycaemia, gender and glycaemic control was also tested. Findings Diabetes care responsibility increased over time for total (P < 0.001), daily (P= 0.002) and non‐daily (P < 0.001), but the associations of self‐efficacy and gender with diabetes care responsibility were moderated by living situation. Self‐efficacy was negatively related to total (P= 0.006), daily (P= 0.010) and non‐daily (P= 0.030) responsibility for those not living independently while positively related only to total responsibility (P= 0.028) for those living independently. Being female was positively related to total (P= 0.007) and non‐daily (P= 0.001) responsibility for those living independently. Conclusion Diabetes care responsibility increased from high school to post high school among these emerging adults with diabetes. There is a complex relationship between self‐efficacy, gender and responsibility related to living independently of parents for these youth.     

The physical functioning and mental health of informal carers: evidence of care‐giving impacts from an Australian population‐based cohort

Informal carers represent a substantial proportion of the population in many countries and health is an important factor in their capacity to continue care‐giving. This study investigated the impact of care‐giving on the mental and physical health of informal carers, taking account of contextual factors, including family and work. We examined health changes from before care‐giving commenced to 2 and 4 years after, using longitudinal data from the Household Income and Labour Dynamics in Australia survey. The sample comprised 424 carers and 424 propensity score‐matched non‐carers. Health was self‐assessed, measured with the SF‐36 Health Survey Mental Health (MH) and Physical Functioning (PF) scales. Care‐giving was classified as non‐carer, low (<5 hours/week), moderate (5–19 hours/week) and high (20 or more hours/week). PF and MH change scores were regressed on baseline scores, care‐giving, covariates (including work, family and socio‐demographic characteristics) and interactions to identify impacts for subgroups. The physical and mental health impacts differed by gender, and care‐giving hours and carer work hours were important contextual factors. Deterioration in both PF and MH was worse for females after 2 years and deterioration in MH was worse for males after 4 years. Among carers aged 40–64 years, there was a 17‐point decline in PF (P = 0.009) and a 14‐point decline in MH (P < 0.0001) after 2 years for female high caregivers working full‐time and 9.3 point improvement (P = 0.02) for non‐working male high caregivers. Change was not significant for non‐carers. The study found that not all carers suffer adverse health impacts; however, the combination of high levels of care‐giving with workforce participation can increase the risk of negative physical and mental health effects (particularly in female carers). Working carers providing high levels of care represent a vulnerable subgroup where supportive and preventive services might be focused.     

Success of case management for medical aid initiative in Korea

The purpose of this cross‐sectional study was to determine the effects of case management of Korea Medical Aid on recipients' satisfaction, ability to handle health problems, health behaviour, quality of life (QoL), hospital visiting days and medical expenditure. Data from structured interviews and claim data from medical institutions to the Korea National Health Insurance Corporation were used. Survey data were collected by questionnaire during September 2008. There were 647 responses out of 1069 (response rate 60.5%), but 260 were excluded from the analyses in this paper because they had received case management for <18 months. This left 269 individuals who had received case management services for 18 months continuously and 118 who had received no case management services in the same time period. Among the former group, 86.9% were satisfied or strongly satisfied with the initiative. Results indicate that the satisfaction for the case management was very high. Although there was no difference in terms of health behaviour and QoL between the two groups, the overall ability to handle health problems was higher in the case management group (P < 0.001). As for healthcare use, the programme produced a significant reduction in hospital visiting days (P = 0.034), and while the mean increase in cost from 2007 to 2008 was 29.1% lower for individuals in the programme, the difference between the groups was not significant (P = 0.851). Case management in Korea is in its early stages, and efforts should be made to extend this approach.     

Self‐directed community services for older Australians: a stepped capacity‐building approach

Consumer‐directed care (CDC) is increasingly widespread among aged care service options in Organisation for Economic Co‐operation and Development (OECD) countries. However, the evidence base regarding the programmatic and contextual factors that affect the outcome of CDC interventions is surprisingly small. This paper reports on a self‐directed care approach for older Australians with complex care needs. A multi‐methods longitudinal comparative cohort study was employed comprising 4 survey tools and 56 semi‐structured interviews. Participation rates were around 20%. A total of 185 (98 in the intervention and 87 in the control group) older people and carers were recruited at baseline. Eleven months later, 109 participants (59 in the intervention and 50 in the control group) completed the repeat measure. Attrition rates were around 40%. Data collection occurred between July 2010 and April 2012. The data suggest that intervention group participants were likely to be more satisfied with the way they were treated (P = 0.013), their care options (P = 0.014), the ‘say’ they had in their care (P < 0.001), the information they received regarding their care (P = 0.012), what they were achieving in life (P = 0.031), that the services changed their view on what could be achieved in life (P = 0.020) and with their standard of living (P = 0.008). The evaluation suggests that while only a very small segment of older people is interested in a voucher or cash option, a substantially larger group would like to have greater say over and more direct access to their care, without, however, assuming administrative and financial responsibilities. The paper concludes that a stepped capacity‐building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people's care outcomes.     

Tackling the needs of the homeless: a controlled trial of health advocacy

The objective of the present study was to assess the effectiveness of a health advocate's casework with homeless people in a primary care setting in terms of improvements in health‐related quality of life (QoL). The impact of the health advocacy intervention was assessed in a quasi‐experimental, three‐armed controlled trial. Homeless people moving into hostels or other temporary accommodation in the Liverpool 8 area of the UK and patients registering at an inner‐city health centre as temporary residents were allocated in alternating periods to health advocacy (with or without outreach registration) or ‘usual care’ over a total intake period of 3 years. Health‐related QoL outcomes were assessed using three independent self‐report measures: the Life Fulfilment Scale; the Delighted–Terrible Faces Scale; and the Nottingham Health Profile. Out of the 326 homeless people who were given baseline questionnaires at registration, 222 (68%) returned usable questionnaires. Out of these individuals, 171 (77.0%) were traceable at follow‐up, and 117 (68.4%) follow‐up questionnaires were returned. The majority of respondents (n = 117) were women (72%) who were under 30 years of age (74%), white British (91%), and single (63%) or separated (23%), many of whom were living with their children (41%) in either women's refuges (30%) or family hostels (25%). Improvements in health‐related QoL were greatest in people recruited and supported by a health advocate early in their stay in temporary housing, in comparison with those in the control group given ‘usual care’ at the health centre. The model of streamlined care for patients with complex psycho‐social needs is shown to be a worthwhile and effective option for primary healthcare providers.     

Physical health literacy of student–athletes

Student–athletes are a vulnerable population who face many unique stressors and often engage in risky physical behaviours. Understanding that high levels of health literacy (HL) can lead to improved health knowledge and decreased negative health outcomes, the purpose of this study was to assess the HL of both student–athletes and their non-athlete peers attending NCAA Division I, II and III institutions. Specifically, guided by Nutbeam's (2000) framework of HL, we assessed functional, communicative and critical HL in 205 student–athletes and 205 non-athlete students using the All Aspects of Health Literacy Scale. Compared to non-athletes, student–athletes had lower functional HL (b = 0.20; p < .001; d = 0.21), lower communicative HL (b = 0.12; p < .01; d = 0.13) and higher critical HL (b = 0.11; p < .05; d = 0.11). These findings suggest that additional interventions may be needed to increase the self-sufficiency of student–athletes to care for personal physical health. As social work in sport is an emerging subspecialty of the profession, social workers may consider increased involvement in advocating for this group by working with individuals, coaches and teams to decrease stigma in requesting health services, attending to the complexity of interacting systems and stressors in student–athletes' lives in therapeutic interventions, and connecting them to empowering health education resources.     

Trends in hepatitis B prevalence and associated risk factors among Indigenous and non‐Indigenous prison entrants in Australia, 2004 to 2013

Objective : This study describes and compares prevalence trends of markers for hepatitis B (HBV) from 2004 to 2013 and HBV risk factors between Indigenous and non‐Indigenous prison entrants. Methods : A cross‐sectional survey carried out over two weeks in 2004, 2007, 2010 and 2013 in reception prisons in New South Wales, Queensland, Western Australia and Tasmania. Results : The study included 2,223 prison entrants; 544 were Indigenous. Indigenous prison entrants had significantly higher hepatitis B core antibody (anti‐HBc) prevalence than non‐Indigenous prisoners in 2004 (29% vs. 18%, P=0.026), 2007 (40% vs. 15%, P<0.001) and 2010 (21% vs. 16% 2010, P=0.002), and similar anti‐HBc prevalence to non‐Indigenous entrants in 2013 (14% vs. 14%, P=0.888), with a significant decline from 2007 for Indigenous entrants (P=0.717)^?. Being more than 30 years old and coming from an area classified as ‘non‐highly accessible’ were associated with anti‐HBc positivity in both populations. For Indigenous prison entrants, first time in prison and survey year was associated with anti‐HBc positivity. For non‐Indigenous participants, a history of injecting drug use and body piercings was associated with anti‐HBc positivity. Conclusion : There are unique risk factors associated with HBV prevalence for both Indigenous and non‐Indigenous prison entrants. Implications for public health : In developing public health programs and policies for HBV, consideration of similarities and differences of associated HBV risk factors between Indigenous and non‐Indigenous offenders is required.     

The impact of health literacy on knowledge,Attitude and decision towards hospice care among community‐dwelling seniors

The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community‐dwelling elderly participants. This cross‐sectional study enrolled 990 community‐dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer‐administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.     

The mental health of single homeless people in Northampton hostels

Much research evidence about homelessness and health relates to large population centres with correspondingly large homeless populations. Such results may not necessarily apply to small towns such as Northampton. A local need was identified for information relating to health and access to health care for homeless people.Seventy five single, homeless people temporarily residing at open access hostels in Northampton were interviewed.The interviews covered:

• recent accommodation histories

• recent physical health

• mental health

• access to health care

• current social contacts, life style and aspirations

The General Health Questionnaire (GHQ30) was administered to allow assessment of the levels of mental morbidity in the population studied.The results presented here relate to mental health issues. Current mental health problems were reported by 53% of thesample (40 people); of these only 40% (16 people) were receiving treatment. Three people had been admitted to a psychiatric hospital within the past year. Using standard scoring, the GHQ30 identified as cases 72% (44) of the 61 homeless people who completed the GHQ.It was concluded that levels of mental morbidity were higher in the homeless group than would be expected in the general population. This finding, mirrors those of studies in larger population centres.The main form of access to mental health services appeared to be via hospital admission. Any GP treatment offeredwas likely to be medication. There was no mention of Community Psychiatric Nurse involvement in treatment or care.The results may indicate a significant level of umnet need for mental health intervention amongst the local homeless population.     

Disease patterns of the homeless in Tokyo

In recent years, homelessness has been recognized as a growing urban social problem in various countries throughout the world. The health problems of the homeless are considerable. The purpose of this study was to elicit, with sociodemographic profiles, the disease patterns among Tokyo's homeless. The subjects were 1,938 men who stayed at a welfare institution from 1992 to 1996. Diagnosed diseases/injuries and sociodemographic profiles were analyzed. The disease patterns of the homeless were compared to those of the male general population. Of the subjects, 8.3% were admitted to the hospital; 64.0% received outpatient care. Their observed morbidity rates by disease category were greater than those of the male general population in both Japan and Tokyo. Comorbidity of alcoholic psychosis/alcohol-dependent syndrome to both liver disease and pulmonary tuberculosis were greater than the average (P<.01). Construction work brought a higher risk of pulmonary tuberculosis (odds ratio=2.0) and dorsopathies (odds ratio=1.4) than did other jobs (P<.05). Disease patterns among the homeless in Tokyo were characterized by alcoholic psychosis/alcohol-dependence syndrome; liver disease; pulmonary tuberculosis; diabetes mellitus; fractures, dislocations, sprains, strains; hypertension; and cerebrovascular disease. Although the sociodemographic backgrounds of Tokyo's homeless have become more diverse, the principal occupation of the homeless was unskilled daily construction work, which underlay the characteristics of their disease patterns.     

NHS commissioning in probation in England – Still on a wing and a prayer

Policy reforms in England and Wales mean that all individuals released from prison will have some contact with probation services, either serving a community sentence, or being on licence post‐release. Despite often having complex health needs, including a higher prevalence of mental health problems, substance misuse problems and physical health problems than the general population, this socially excluded group of people often do not access healthcare until crisis point. This is partly due to service‐level barriers such as a lack of appropriate and accessible healthcare provision. We conducted a national survey of all Clinical Commissioning Groups (CCGs, n = 210) and Mental Health Trusts (MHTs, n = 56) in England to systematically map healthcare provision for this group. We compared findings with similar surveys conducted in 2013 and 2014. We had excellent response rates, with the data analysed here representing responses from 75% of CCGs and 52% of MHTs in England. We found that just 4.5% (n = 7) of CCG responses described commissioning a service specifically for probation service clients, and 7.6% (n = 12) described probation‐specific elements within their mainstream service provision. Responses from 19.7% of CCGs providing data (n = 31) incorrectly suggested that NHS England are responsible for commissioning healthcare for probation clients rather than CCGs. Responses from 69% (n = 20) of MHTs described providing services specifically for probation service clients, and 17.2% (n = 5) described probation‐specific elements within their mainstream service provision. This points to a need for an overarching health and justice strategy that emphasises organisational responsibilities in relation to commissioning healthcare for people in contact with probation services to ensure that there is appropriate healthcare provision for this group.     

Chlamydia sentinel surveillance in Aboriginal Community Controlled Health Services finds higher testing and positivity rates among younger people

Objective: To measure chlamydia testing and positivity rates among 16–39 year olds attending Aboriginal Community Controlled Health Services (ACCHSs). Methods: Retrospective non‐identifiable computerised records containing consultation and chlamydia testing data were collected for patients (16–39 years) attending eight ACCHSs during 2008–09 in urban, regional and remote settings for the Australian Collaboration for Chlamydia Enhanced Sentinel Surveillance (ACCESS) system. Annual chlamydia testing and positivity rates were estimated. Results: Over two years, 13,809 patients aged 16–39 years (57.8% female, 82.3% Aboriginal or Torres Strait Islander) attended. The annual overall chlamydia testing rate was 13.0% (2008) and 16.0% (2009). Testing rates were higher among females (p<0.001) and among patients aged 16–29 than 30–39 years (males: p=0.01; females: p<0.001). Chlamydia positivity was 8.5% overall; similar in females (8.7%) and males (7.8%) (p=0.46); highest among 16–19 years (females: 17.4%; males: 13.0%), declining to 1.5% among females 35–39 years (p<0.001) and 4.8% among males 30–34 years (p<0.001). Conclusions: Chlamydia testing at these ACCHSs approached recommended levels among some patient groups, however, it should increase. High positivity among younger people highlights they should be targeted. Implications: Young people should be targeted for sexual health interventions. ACCHSs are well placed to provide enhanced sexual health services if appropriately resourced.