Region I IPP

1. Region I IPP Clinic Staff and Provider Assessment Kim Watson, Jennifer Kawatu

2. Provider Assessment The primary goal is to inform the project around improvement of the regional IPP Performance measures – screening coverage and adherence to screening criteria. As a result of this assessment, the reasons for non-adherence to Chlamydia screening criteria at the provider level will be identified and possible opportunities for improvement can be proposed

3. Provider Assessment • Step 1: KII’s conducted with 8 providers • Current practices • Why screen? • Awareness of regional screening criteria

4. Provider Assessment Preliminary findings from the key informant interviews indicate reasons for lack of adherence are: • unawareness of the screening criteria, • lack of buy-in, • poor documentation of risk factors?, • under-/ over-estimation of risk.

5. Provider Assessment “I don’t know what the CDC ones are, but here we basically screen everybody. If somebody comes into the office, and cannot show me documented evidence of a negative CT screen in the past year, I will do a screening.” “For anyone coming in I offer it – I always ask if she’s interested in it – my clinical practice is to offer it to everyone regardless of age – and leave it up to them to decide.”

6. Provider Assessment Step 2: Survey • Web-based data collection • Invitation via FP partners and IPP AB representatives • Provider population • MA/and rest of states split up

7. Provider Assessment • N=302 • 75%= Target audience - MD/NP,RN, FP/HIV Counselor • 37% are MD/NPs • 13% are RN/LPN • 25% FP/HIV Counselors

8. Provider Assessment

9. State Participation

10. Provider Assessment Findings EMR

11. IPP or Not to IPP • 34% IPP • 26% Not IPP • 38% Don’t Know • Among MD/NP’s 40% didn’t know IPP project or not • 33% of MD/NP and RN’s didn’t know

12. Provider Assessment - Results Chlamydia Screening - Practices • Providers estimated that their clinic’s average Chlamydia positivity rate is 10.3%

13. Screening practices IPP

14. “I offer Chlamydia testing to everyone and leave it up to them to decide” True: 66% Overall 62% of IPP 79% of FP Clinic Representatives 73.4% of MD/NP Only’s “I screen everyone I can” True: 46% Overall 34% IPP 52% FP Clinic Representatives 52% MD/NP Only’s

15. Provider Assessment - Results Chlamydia Screening – CDC Recommendations Screen all sexually active females under 26 at least once a year and women over 26 who are at increased risk. No screening criteria for males Screen all sexually active males and females under 26 at least once a year and women and men over 26 who are at increased risk Screen all women of childbearing age and pregnant women

16. Provider Assessment - Results Provider’s Opinions on EPT • 25% of responders currently practice EPT in their clinics

17. Source of Info re: CT screening General • 10% hears from IPP rep • 24% of those who know they are in IPP project hear from IPP rep – Clinic Specific 8% hears from IPP rep 21% of those who know they are in IPP say they hear from IPP rep -

18. Provider Assessment - Results Chlamydia Screening – Rescreening Practices Provider’s estimate… • 50.3% of women treated for Chlamydia come back to be re-screened • 10% of those re-screened are positive (although 40% estimate less than 3%)

19. Re-screening Practices • “Ask patients to contact us and make appointment when re-screen time has arrived” • 50% general • 58% of FP representatives • 67% of IPP “Yes” • “Ask Pts. To come back for ‘Test of Cure’” • 30% general • 40% of MD/NP’s and RN’s • 24% IPP “Yes”

20. Pregnancy Test Only

21. Pregnancy Test Only

22. Next Steps: • Further analysis of survey findings • Send results to you by state, by? • Focus groups (TBD) • Performance Improvement Plan Questions? Ideas?