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Forward Genetic Approaches in Chlamydia trachomatis
Published on: October 23, 2013
The role of Medicaid managed care interventions in Chlamydia screening by physicians
Nadereh Pourat1, Gerald F Kominski, Jas Nihalani
1School of Public Health, University of California-Los Angeles, Los Angeles, CA 90024, USA. pourat@ucla.edu
Insights
Health maintenance organizations (HMOs) can improve physician adherence to Chlamydia trachomatis (CT) screening guidelines through targeted interventions. Tailored approaches and physician acknowledgment of guidelines enhance screening rates for young females.
Area of Science:
- Public Health
- Infectious Disease Prevention
- Healthcare Management
Background:
- Current guidelines recommend annual Chlamydia trachomatis (CT) screening for sexually active young females.
- Previous research indicated inconsistent CT screening guideline recommendations by Medicaid Health Maintenance Organizations (HMOs).
- Physicians in HMO practices showed higher guideline compliance than those outside HMOs.
Purpose of the Study:
- To examine the relationship between HMO interventions and physician adherence to annual CT screening guidelines.
- To assess the impact of HMO strategies on screening practices for sexually active females aged 15-25.
Main Methods:
- Surveyed 17 California Medicaid HMOs regarding interventions to promote CT screening.
- Surveyed 941 primary care physicians contracted with these HMOs on their screening frequency.
- Utilized logistic regression models for data analysis.
Main Results:
- HMO recommendations for CT screening were linked to higher physician screening frequency in unadjusted models.
- HMO recommendations significantly increased screening odds, but other interventions' effects diminished after controlling for physician characteristics.
- Physician training, feedback from HMOs, and access to guidelines were associated with increased screening frequency.
Conclusions:
- Effective improvement in physician adherence to CT screening guidelines necessitates refined, targeted interventions.
- Interventions are more impactful when tailored to physician characteristics and delivered in formats they acknowledge and perceive.
Background:
Chlamydia trachomatis (CT) guidelines call for annual screening of all sexually active young females. In previous studies, Medicaid health maintenance organizations (HMOs) did not consistently recommend CT and other sexually transmitted disease guidelines, but physicians with HMO practices were more likely to comply with guidelines than those without HMO practices. This study examines the relationship between HMO interventions and physician adherence to annual (CT) screening guidelines for sexually active young (ages 15-25) females.
Methods:
Medicaid HMOs (N = 17) of California were surveyed regarding their interventions to increase physician adherence with national CT screening guidelines in 2002. Primary care physicians (N = 941) who contracted with these HMOs were also surveyed on their frequency (always/usually) of CT screening. Data were analyzed using logistic regression models.
Results:
HMO-reported recommendations for CT screening and other interventions were associated with significantly higher odds of frequent CT screening by contracted physicians in unadjusted models. HMO recommendations to screen young females increased the odds of frequent CT screening, but other interventions were no longer significantly associated after controlling for physician characteristics. Physicians also had higher odds of reporting frequent CT screening if they had received training in the past, had received feedback from their contracted HMOs, or reported having access to national CT screening guidelines. Physician gender, specialty, years of clinical experience, and other factors were also significantly associated with the odds of frequency of CT screening.
Discussion:
Improving physician adherence with CT screening guidelines requires a refinement of current approaches with targeted interventions that are tailored to the characteristics of physicians. In addition, interventions are more likely to be effective if provided in formats that are perceived and acknowledged by physicians.
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