Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings

Taylor, Melanie; Frasure-Williams, Jessica; Burnett, Phyllis; Park, Ina U.

doi:10.1097/olq.0000000000000294

Cited by 52 publications

(44 citation statements)

References 60 publications

(152 reference statements)

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“…The strategy of providing continuing education credit has been demonstrated to improve human papillomavirus vaccination coverage in our network as well, and should be considered in future QI interventons. 30 Our results are consistent with a moderate intervention effect per the criteria identified by Taylor et al in their metaanalysis of STI screening interventions, 21 and are similar to the effect sizes identified in other recent screening interventions in the pediatric and adolescent clinical setting. We identified challenges in implementation largely related to role definition and work flow.…”

Section: Discussionsupporting

confidence: 89%

“…In a meta-analyses by Taylor et al, automatic collection of urine specimens as part of routine visits was identified as a moderately to highly effective and low-cost intervention to improve STI screening rates. 21 Our data reaffirm this finding, and provide additional support on how to implement this change in routine pediatric care. Other strengths of our intervention, and likely contributors to a higher than anticipated level of success, included the involvement and engagement of all levels of multidisciplinary clinical staff, the use of process mapping to identify site-specific barriers to facilitators of screening before intervention development, and the use of practice feedback to motivate ongoing behavior change.…”

Section: Discussionsupporting

confidence: 76%

“…18,29 However, the data are mixed on the efficacy for interventions using provider education as the sole or central component. 15,21 In addition to provider education, we used several strategies to enhance provider engagement, including providing MOC credit and sending screening run charts to the clinic staff to motivate ongoing behavior change. The strategy of providing continuing education credit has been demonstrated to improve human papillomavirus vaccination coverage in our network as well, and should be considered in future QI interventons.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care

Wood

McGeary

Wilson

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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Study Objective: To determine the impact of a multicomponent quality improvement (QI) intervention on Chlamydia trachomatis screening for young women in primary care. Design: Observational cohort analysis. Setting: Urban primary care site providing adolescent primary and confidential sexual health care. Participants: Female adolescents aged 15-19 years. Interventions: From December 2016 to April 2018, we designed and implemented a multiphase QI intervention. The final intervention, beginning March 2017, consisted of the following at all adolescent well visits: (1) dual registration for well and confidential sexual health encounters; (2) urine collection during the rooming process; and (3) electronic health record-based prompts for chlamydia screening. Main Outcome Measures: Annual chlamydia screening rates before and after the intervention, with a goal of achieving a relative increase of 10%. Results: There were 1550 well adolescent encounters from December 2016 to April 2018. The preimplementation chlamydia screening rate among 15-to 19-year-old female adolescents was 312/757 (41.2%) (95% confidence interval, 20.9%-61.5%). Postintervention, this increased to 397/793 (50.0%) (95% confidence interval, 28.6%-71.5%; P ! .001). The clinic chlamydia test positivity rate remained stable, at 10.7% and 11.1% in the pre-and postintervention periods, respectively. There was no significant change in median visit length in the pre-(79.2 minutes; interquartile range, 59.5-103.3) and postintervention periods (80.4 minutes; interquartile range, 61.7-102.8; P 5 .63). Conclusion: This practice-based QI intervention resulted in a statistically significant 21% relative increase in annual Chlamydia trachomatis screening rates among female adolescents, without lengthening median visit time.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care

Wood

McGeary

Wilson

et al. 2019

Journal of Pediatric and Adolescent Gynecology

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“…these are typically found to be effective as de ned as signi cant increases in the proportion tested or the frequency of testing (23,24). Indeed, in the ESSAHM Trial, we observed a three-fold increase in the odds of having at a least one syphilis test per year, and a doubling in the number of tests per year (25).…”

Section: Discussionmentioning

confidence: 83%

Patient Perspectives on the Implementation of Routinised Syphilis Screening With HIV Viral load Testing: Qualitative Process Evaluation of the Enhanced Syphilis Screening Among HIV-positive Men Trial

MacKinnon

Grewal²,

Tan³

et al. 2020

Preprint

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Background: Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. Methods: Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. Results: A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. Conclusions: Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.

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“…A recent study found that cost-effective interventions can be successfully designed to routinely collect specimen for STD testing by changing patient flow in clinical setting, using screening reminders through electronic health record systems, and training staff for frequent reminders to patients via text, e-mail, or postcard to encourage screening or re-screening for STDs. 21 …”

mentioning

confidence: 99%

The Proportion of Young Women Tested for Chlamydia Who Had Urogenital Symptoms in Physician Offices

2018

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Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings

Abstract: Successful interventions include changing clinic flow to routinely collect specimens for testing, using EHR screening reminders, and reminding patients to get screened or rescreened. These strategies can be tailored to different clinic settings to improve screening at a low cost.

Cited by 52 publications

References 60 publications

Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care

Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care

Patient Perspectives on the Implementation of Routinised Syphilis Screening With HIV Viral load Testing: Qualitative Process Evaluation of the Enhanced Syphilis Screening Among HIV-positive Men Trial

The Proportion of Young Women Tested for Chlamydia Who Had Urogenital Symptoms in Physician Offices

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