Differences in Treatment of Chlamydia trachomatis by Ambulatory Care Setting

Abstract

Chlamydia trachomatis (CT) is the most commonly reported sexually transmitted infection (STI) in the US and timely, correct treatment can reduce CT transmission and sequelae. Emergency departments (ED) are an important location for diagnosing STIs. This study compared recommended treatment of CT in EDs to treatment in physician offices. Five years of data (2006-2010) were analyzed from the National Ambulatory Medical Care Survey, and the National Hospital Ambulatory Medical Care Surveys (NHAMCS), including the Outpatient survey (NHAMCS-OPD) and Emergency Department survey (NHAMCS-ED). All visits with a CT diagnosis and those with a diagnosis of unspecified venereal disease were selected for analysis. Differences in receipt of recommended treatments were compared between visits to physician offices and emergency departments using Chi square tests and logistic regression models. During the 5 year period, approximately 3.2 million ambulatory care visits had diagnosed CT or an unspecified venereal disease. A greater proportion of visits to EDs received the recommended treatment for CT compared to visits to physician offices (66.1 vs. 44.9 %, p < .01). When controlling for patients' age, sex and race/ethnicity, those presenting to the ED with CT were more likely to receive the recommended antibiotic treatment than patients presenting to a physician's office (OR 2.16; 95 % CI 1.04-4.48). This effect was attenuated when further controlling for patients' expected source of payment. These analyses demonstrate differences in the treatment of CT by ambulatory care setting as well as opportunities for increasing use of recommended treatments for diagnosed cases of this important STI.

The role of primary care providers in testing for sexually transmitted infections in the MassHealth Medicaid program

“…In the United States, Medicaid is a public insurance program for low-income families and individuals with disabilities; it covers more care related to sexually transmitted infections (STIs)-including syphilis, chlamydia, and gonorrhea-than any other payment source, and insures a larger proportion of the population in need of STI care [1,2]. Care for STIs is received in various settings, with increasing national utilization trends in emergency departments and urgent care centers [3][4][5]. Recent analyses of sexual health services provided in two state Medicaid programs found large differences in the location of where care was sought [6].…”

Undertreatment of chlamydia and gonorrhea among pregnant women in the emergency department

“…15 When an individual presents to a provider with suspected chlamydia or gonorrhea, or the individual is a named contact to a test-positive partner, immediate clinical treatment with antibiotics is the epidemiologically appropriate course. To ensure the complete suppression of potential chlamydia and gonorrhea infection, empiric treatment at the time of visit is common in EDs 16 and other settings. 9 Pregnant women with STIs have been established as a patient population warranting special attention.…”

Increase in Urgent Care Center Visits for Sexually Transmitted Infections, United States, 2010–2014

“…Visits to urgent care centers have increased over time, and our findings demonstrate that visits to urgent care centers for STI care in particular have dramatically increased. Previous work has highlighted differences in the use of antibiotics to treat chlamydia in emergency departments compared with physician offices ( 10 ) suggesting that differences might also exist in the treatment of STIs in urgent care centers compared with other healthcare settings. Given the increases in STIs, increases in antimicrobial drug resistance, and increases in use of urgent care centers for STI care, further work is needed to determine how STIs are being managed in this venue to ensure quality care.…”