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STD Knowledge and Practices of New York City Providers

This study examines the frequency and predictors of Chlamydia screening among adolescent female patients in NYC. Results show provider characteristics influencing screening adherence and knowledge of reporting laws. Recommendations include targeted training and system-level interventions.

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STD Knowledge and Practices of New York City Providers

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  1. 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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Results

  10. 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

  11. NYC Providers' Chlamydia and Gonorrhea Screening Practices for Female Adolescents

  12. MV: Predictors of CT Screening I

  13. MV: Predictors of CT Screening II

  14. Knowledge of Reporting Laws

  15. Self-Reported Proficiencies

  16. 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

  17. 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

  18. 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

  19. 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)

  20. 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

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