Increased Gonorrhea Screening and Case Finding After Implementation of Expanded Screening Criteria—Urban Indian Health Service Facility in Phoenix, Arizona, 2011–2013

Patton, Monica E.; Kirkcaldy, Robert D.; Chang, Douglas C.; Markman, Stephanie; Yellowman, Marilyn; Petrosky, Emiko; Adams, Laura; Robinson, Candice L.; Gupta, Akash; Taylor, Melanie

doi:10.1097/olq.0000000000000457

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…[8][9][10][11][12][14][15][16][17][18][19] Studies have shown, however, that EHR reminders alone have a limited positive effect on preventive care: in a review of 28 trials of EHR-based screening reminders, the median improvement rate for the measures evaluated was 4.2%. [14][15][16][17][18][19] "Alert fatigue"-induced by information overload-may limit the benefits of EHR reminder systems. Evaluations of alert fatigue and barriers to clinical decision support systems highlight the effect of these factors on health care providers.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population

et al. 2020

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Objectives Indian Health Service (IHS) screening rates for Chlamydia trachomatis are lower than national rates of chlamydia screening in the Southwest. We describe and evaluate the effect of a public health intervention consisting of electronic health record (EHR) reminders to alert health care providers to screen for chlamydia at an IHS facility. We also conducted an awareness presentation among health care providers on chlamydia screening. Methods We conducted our intervention from November 1, 2013, through October 31, 2015, at an IHS facility in the Southwest. We implemented algorithms that queried database values to assess chlamydia screening performance in 6 clinical departments. We presented data on the screening performance of clinical departments and health care providers (de-identified) in the awareness presentations. We re-queried database values 1 and 2 years after implementation of the EHR reminder intervention to evaluate before-and-after screening rates, comparing data among all patients and among female patients only. Results We found small, sustained relative increases in chlamydia screening rates during the 2012-2015 evaluation period: 20.8% pre-intervention to 24.9% and 24.2% one and two years postintervention, respectively, across all patients; 32.3% preintervention to 36.6% and 35.6% one and two years postintervention, respectively, among female patients. Increases in clinical department–specific screening rates varied and were most prominent in internal medicine (35.8% preintervention to peak 65.8% postintervention). The 1 clinic (obstetrics–gynecology) that did not receive an awareness presentation showed a consistent downward trend in screening rates, although absolute rates were consistently higher in that clinic than in other clinics. Conclusions Awareness presentations that offer feedback to health care providers on screening performance, heighten provider awareness of the importance of chlamydia screening, and promote development of novel provider-initiated screening protocols may help to increase screening rates when combined with EHR reminders.

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Section: Discussionmentioning

confidence: 99%

Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population

et al. 2020

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“…Second, this study draws on an unconventional and nuanced approach to sexual health self-care through the use of self-assessments combined with personalized messaging, and self-administered non-clinic based STI screening. These approaches have the potential for widespread uptake within communities served by Indian Health Service, and provide complementary alternatives to provider-driven, clinic-based care [4, 11, 13, 16]. Third, the self-assessment will include a risk prediction/clinical prediction rule to assist with identifying those at greatest risk for STIs, which is urgently needed in this and other settings where STI rates are climbing.…”

Section: Discussionmentioning

confidence: 99%

“…Further, because many STIs can be treated free of charge within the Indian Health Service (IHS), differential access to screening and treatment may explain these disparities [3]. Data from IHS corroborate inequalities in access to care, namely underutilization of services by higher risk groups and a lack of universal promotion of sexual health care by providers [4, 11].…”

Section: Introductionmentioning

confidence: 99%

Protecting our future generation: study protocol for a randomized controlled trial evaluating a sexual health self-care intervention with Native American youth and young adults

et al. 2019

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BackgroundDisparities in sexually transmitted infections (STI) are an urgent problem among Native American youth and young adults which are not fully explained by different sexual or related behaviors. These sexual health disparities are more likely attributed to social environments and structural determinants such as a shortage of sexual healthcare providers, lower socioeconomic status, and access barriers to STI screening and treatment, including geographic isolation and confidentiality concerns. Innovative, non-clinic based alternatives to promote STI screening and treatment are essential for alleviating these disparities. Self-care, or the care taken by individuals towards their own health and well-being may be such a strategy. This study will assess the efficacy of a self-care intervention, called Protecting Our Future Generation, for increasing uptake of STI screening and impacting sexual risk and protective behaviors among Native American youth and young adults living in a reservation-based community in the Southwestern United States.MethodsThe proposed study is a randomized controlled trial to test the efficacy of a self-care intervention compared to a control condition. Participants will be Native Americans ages 14–26 years old who have had vaginal or anal sex at least once in their lifetime. Participants will be randomized to the intervention which includes: 1) a sexual health self-assessment with embedded clinical prediction tool predicting STI positivity, and 2) personalized messaging with key steps to lower risk for STIs, or the control condition which includes: 1) a self-assessment about water, soda and sugar sweetened beverage consumption, and 2) personalized messaging to meet recommended daily intake. All participants will be offered a self-administered STI test. Participants will complete assessments at baseline, 3- and 6-months follow-up. The primary outcome measure is completion of STI screening.DiscussionProtecting Our Future Generation is among the first self-care interventions uniquely focused on sexual health among a Native American population, who endure significant sexual health disparities and are under-represented in research. If efficacious, the intervention will be a model of sexual health self-care for Native American youth and young adults adaptable for use in healthcare and community-based settings.Trial registrationClinical Trials: http://clinicaltrials.gov; NCT03895320; Registered 03/28/2019.

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“…Six references described an outbreak response for syphilis 4 and gonorrhoea. 2 STI testing and treatment within the Indian Health System are primarily provided in outpatient clinics and emergency departments 37,[73][74][75][76][77][78][79][80][81] and are delivered according to national guidelines. 73 Expedited partner therapy (EPT) is available in some clinical settings.…”

Section: Clinical Service Deliverymentioning

confidence: 99%

“…83,84 Clinical decision support in electronic health records is utilised at many facilities as testing bundles or screening reminders for bacterial STIs and HIV with a single order set to enhance screening. [76][77][78][79] In some situations, such as outbreaks or in review of local epidemiology, STI screening and clinical decision support can be expanded based on local policy and practice needs. 77,80,81 In comparison to non-Hispanic Whites, AI/AN men and women have been reported to more likely seek STI services.…”

Section: Clinical Service Deliverymentioning

confidence: 99%

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review

et al. 2022

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This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.

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Increased Gonorrhea Screening and Case Finding After Implementation of Expanded Screening Criteria—Urban Indian Health Service Facility in Phoenix, Arizona, 2011–2013

Cited by 5 publications

References 14 publications

Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population

Electronic Health Record Reminders for Chlamydia Screening in an American Indian Population

Protecting our future generation: study protocol for a randomized controlled trial evaluating a sexual health self-care intervention with Native American youth and young adults

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review

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