Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California

Abstract

BACKGROUND: Because sexually transmitted chlamydial infections are common among young women, it is critical that providers screen and manage these infections appropriately.

A Conceptual Framework for Understanding and Reducing Overuse by Primary Care Providers

“…A number of studies on overuse of primary care services identify attributes of patients, practitioners, or provider organizations that are correlated with overuse. For example, inordinately high use of some primary care procedures has been associated with patients who are male (Diette et al, 1999) or frequent health care users (Partin et al, 2012; Walter et al, 2009); PCPs who are nonphysicians (Guerry et al, 2005; Roumie et al, 2005), older (Kerfoot, Holmberg, Lawler, Krupat, & Conlin, 2007), or have a greater practice volume (Cadieux, Tamblyn, Dauphinee, & Libman, 2007); and rural and for profit organizations (Mathias, Feinglass, & Baker, 2012). Although these studies can improve the prediction of when overuse is more likely to occur, they do not specify why it occurs.…”

Sexual History Taking in the Emergency Department – More Specificity Required

“…Although routine screening of sexually active females under age 26 years has been found to be cost-effective when the prevalence is $ 3.1%, the same has not been found to be true for males or other bacterial STIs such as gonorrhea. There is also considerable uncertainty regarding reimbursement for such screening, especially for asymptomatic individuals (and the majority of those infected are asymptomatic) in both the primary care and emergency setting (23,24). This problem is particularly relevant regarding screening that is unrelated to the presenting complaint, and reimbursement rules vary considerably by both state and insurance coverage.…”

Patient-Delivered Partner Treatment and Other Partner Management Strategies for Sexually Transmitted Diseases Used by New York City Healthcare Providers

“…[22][23][24][25] In California, where PDPT was legalized for laboratory-confirmed chlamydia in 2001, approximately 50% of HCPs surveyed in December 2001/early 2002 reported using it usually or always. 26 Although PDPT is a potentially useful strategy, it could reduce the probability of in-person evaluation for sex partners, and concerns exist that HCPs who use PDPT might be less likely to use other PM strategies with their patients. Fewer in-person evaluations might lead to missed opportunities to educate and counsel patients, diagnose concurrent STDs, and identify upper genital tract disease among women.…”