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STD Knowledge and Practices of New York City Providers. Meighan E. Rogers, MPH Bureau of STD Control, NYC DOHMH Region II IPP Meeting, May 31-June 1, 2006.
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STD Knowledge and Practices ofNew York City Providers Meighan E. Rogers, MPH Bureau of STD Control, NYC DOHMH Region II IPP Meeting, May 31-June 1, 2006
Background Proportion of Chlamydia and Gonorrhea Cases Among Females 15-19, Reported from Department of Health and Mental Hygiene (DOHMH) Clinics, New York City, 2004 Gonorrhea Chlamydia 8.1% 11.5% 91.9% 88.5% Total N=8656 Total N=1723
Background (cont) • Screening recommendations: (USPSTF*) • CT: Routine for sexually active 15-25 year old females • GC: Sexually active women at risk (young, pregnant); no specific time period given * United States Preventive Services Task Force
Background (cont) • Population studies: 35%-74% of providers report annual CT screening* • Varies by provider type/specialty (74% pediatricians; 70% of NP; 47% of primary care prov; 35% of MDs nationally) • Predictors of screening include female providers, adolescent med or ob/gyn specialty, practice in non-private setting, discussion of STD prevention with patients • Knowledge of CT reporting requirement ~50% nationally * Guerry et al., 2005; Torkko et al., 2000; St. Lawrence et al., 2002
Objectives Among NYC providers: • Assess frequency of CT screening for female adolescents • Assess predictors of CT screening for female adolescents • Examine knowledge of reporting requirements • Examine self-reported proficiencies in STD practice
Methods I: Sample • Data Sources: AMA Masterfile and proprietary database • Criteria: • Providers who see patients at least 25% of time • Specialties of internal medicine, ob/gyn, pediatrics, emergency med, family practice, adult health • Surveys mailed to 2000 NYC providers November 2004 • 1,600 MD/DOs, 200 NPs, and 200 PAs
Methods II: Measures • Provider-level variables: • Provider type – MD/DO, NP, PA • Sex • Race • Practice setting (Inpatient, Ambulatory, Emergency) • Specialty • Practice-level variables (in past year): • # CT/GC diagnoses • # patients/week • Frequency of performing sexual history for adolescent females • Outcomes: • Frequency of CT screening • Knowledge of reporting requirements • Self-reported proficiency
Methods III: CT Screening Analysis • Limited to providers who care for female adolescents • Screening frequency - univariate and bivariate χ2 • Test of association btw screening and provider and practice-level variables – bivariate χ2 • Independent predictors of provider CT/GC screening – multivariate (MV) logistic regression
Surveys mailed to random sample of NYC providers: n = 2000 200NP 200PA 1600MD/DO† No/Undeliverable: n = 353 (17.7%) Delivered successfully? Yes delivered: n = 1647 (82.3%) Non-Respondents: n = 952 (57.8%) Response received? Respondents: n = 695 (42.2%) No pt care in NYC: n = 73 (10.5%) Patient care in NYC? Pt care in NYC: n = 622 (89.5%) Patient care for adolescent females? No pt care for adol. females: n=197 Conduct patient care for adol. females: n=425 (68.3%) Analytic Sample
NYC Providers' Chlamydia and Gonorrhea Screening Practices for Female Adolescents
Additional Findings • Knowledge of CT reporting requirement differed significantly by specialty (p<.005) • EM-82%; PD-68%; OB-65%; IM-53% • Proficiency levels in different skill areas varied significantly by specialty • OB and PD reported higher proficiency in taking an adolescent sexual history than IM, EM • Highest interest in additional training re: partner notification services available through DOHMH
Conclusions • Proportion of providers providing annual screening similar to previous surveys (~54%) • Provider type (MD/DO, NP, PA) not significantly assoc with CT/GC screening • Provider characteristics predict screening adherence • Female providers • Specialty type (OBG, FP, Ped–for GC) • Frequently conducting a sexual history during routine visit • Time constraints may be a factor – providers reporting fewer patients more likely to screen • Systems level interventions needed
Conclusions (cont) • Knowledge of reporting laws for CT not high (63%) – need to focus on IM, OB, PD • Focus on increasing proficiency in taking adolescent sex history, talking about same sex issues • Inform providers about DOHMH services
Next Steps • NYC BSTDC CT control strategic plan - 2005 • Development of a City Health Information publication on CT – Summer 2006 • Begin public health “detailing” to promote and educate about screening guidelines; integrate systems level changes • Educate specialty groups through NYC Prevention Training Center (courses, grand rounds)
Acknowledgments • Bureau of STD Control, NYC DOHMH • Contact Information: Meighan Rogers, MPH Bureau of STD Control NYC DOHMH T: 212-788-4428 mrogers@health.nyc.gov