The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70915

Jas Nagra, MPH, CHES¹, Nadereh Pourat, PhD², Romni Neiman³, Heidi M Bauer, MD, MS, MPH³, and Gail Bolan, MD³. (1) California Chlamydia Action Coalition, University of California, San Francisco/ DHS STD Control Branch, 1947 Center Street, Suite 201, Berkeley, CA 94704, 510-540-2758, jnagra@dhs.ca.gov, (2) UCLA Center for Health Policy Research, 10911 Weyburn Avenue Suite 300, Los Angeles, CA 90024-2887, (3) STD Control Branch, California Department of Health Services, 1947 Center St. #201, Berkeley, CA 94704

A cross section of primary care physicians (PCPs) that contracted with Medi-Cal (California’s Medicaid) HMOs in eight California counties were surveyed on their delivery of STD services that corresponded to the CDC and other clinical guidelines. A total of 948 PCPs participated in the telephone survey, with a response rate of 40%. We examined differences in adherence to guidelines by the PCPs based on demographic and business characteristics including specialty, experience, gender, practice setting, recent STD training, Medi-Cal patient load, and number of HMO contracts. We also examined the relationship between perceived barriers by PCPs in delivery of STD counseling and patient education.

Preliminary analyses showed that adherence to guidelines (screening, treatment, testing, reporting, and counseling) varied significantly. Most PCPs (70%) reported always screening 15 to 25 year old female patients annually for chlamydia. PCPs reported using first line CDC recommended treatments 88% of the time for chlamydia and 76% of the time for gonorrhea. Predictors of PCP adherence included: specialty in obstetrics/gynecology and pediatrics (vs. internal medicine and family or general practice), larger volume of Medi-Cal patients in their practice and recent STD training. PCPs identified important challenges to STD education, but despite these perceived barriers PCPs reported conducting STD counseling and providing patient education.

Variations in STD guideline adherence by PCPs caring for California’s Medi-Cal managed care population exist and are associated with demographic and business characteristics. Interventions to improve consistent adherence to STD guidelines can be targeted to groups with lowest levels of adherence to guidelines.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to:
• List at least three PCP perceived barriers to providing STD counseling to patients. 2)Discuss at least two PCP business characteristics that affect adherence to clinical guidelines in providing STD care.

Keywords: STD, Medicaid Managed Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.