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

Abstract #71085

Nadereh Pourat, PhD¹, Jas Nagra, MPH, CHES², Natasha Razack, MPH¹, Heidi M Bauer, MD, MS, MPH³, Romni Neiman³, Richard Brown, PhD¹, and Gail Bolan, MD³. (1) UCLA Center for Health Policy Research, 10911 Weyburn Avenue Suite 300, Los Angeles, CA 90024-2887, 310-794-2201, pourat@ucla.edu, (2) California Chlamydia Action Coalition, University of California, San Francisco/ DHS STD Control Branch, 1947 Center Street, Suite 201, Berkeley, CA 94704, (3) STD Control Branch, California Department of Health Services, 1947 Center St., Suite #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%. Almost all (19/20) Medi-Cal HMOs in the corresponding counties were also surveyed on their promotion of guidelines and STD medications. Dependent variables included PCP adherence to guidelines (screening, treatment, reporting, and counseling. Independent variables were the presence of guidelines on the same topics from the contracted HMOs as reported by HMOs. Logistic models identified the probability of physician adherence given the HMO’s recommendation. Each model was controlled for PCP characteristics such as specialty, experience, practice setting, Medi-Cal patient load, recent STD training.

Preliminary analyses show that PCPs with only one Medi-Cal HMO affiliation are more likely to screen 15 to 25 year old female patients annually for chlamydia. No other HMO guidelines seemed to change the likelihood of PCP practices. Rather, the determinants of consistently following guidelines by PCPs in California’s Medi-Cal HMO varied depending on the guidelines. Although many HMOs reported having STD screening, treatment, and partner management guidelines, only HEDIS chlamydia guidelines are effectively communicated to PCPs. This study confirms that the presence of HEDIS chlamydia screening guidelines has impacted screening by PCPs. Effective communication of additional STD clinical guidelines by HMOs may improve overall STD prevention and treatment by PCPs.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to:
• Describe how Medi-Cal HMO guidelines influence contracted primary care providers’ delivery of STD services.
• Identify which clinical guidelines are most effectively communicated to PCPs.

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.