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

Chlamydia Gonorrhea8.1%

88.5%91.9%

11.5%

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

Results

Analytic Sample

No/Undeliverable:n = 353 (17.7%)

No pt care in NYC:n = 73 (10.5%)

Pt care in NYC:n = 622 (89.5%)

Yes delivered:n = 1647 (82.3%)

Respondents:n = 695 (42.2%)

Surveys mailed to random sample of NYC providers:

n = 2000200NP 200PA 1600MD/DO†

Delivered successfully

?

Response received?

Patient care in NYC?

No pt care for adol. females:

n=197

Conduct patient care for adol. females:

n=425 (68.3%)

Patient care for

adolescent females?

Non-Respondents:n = 952 (57.8%)

NYC Providers' Chlamydia and Gonorrhea Screening Practices for Female Adolescents

MV: Predictors of CT Screening I

Variable Odds Ratio95% Confidence

Interval p value

Provider Specialty

Internal Medicine Ref — —

Obstetrics/Gynecology 6.0 (2.4–15.1) <.0005

Family Practice 2.5 (1.1–5.9) 0.04

Pediatrics 1.5 (0.7–3.4) 0.28

Emergency Medicine 1.3 (0.1–12.8) 0.84

Adult Health 0.4 (0.1–2.9) 0.35

Other 0.3 (0.1–0.96) 0.04

Provider Practice Setting

Ambulatory Care Ref — —

Inpatient 0.8 (0.4–1.7) 0.60

Emergency Department / Urgent Care 0.3 (0.04–2.9) 0.32

Sex of Provider

Male Ref — —

Female 2.8 (1.6–4.8) <.0005

MV: Predictors of CT Screening II

Variable Odds Ratio95% Confidence

Interval p value

Provider Race/Ethnicity

White, non-Hispanic Ref — —

Asian 1.1 (0.6–2.2) 0.70

Black 4.4 (1.4–14.2) 0.01

Hispanic 3.2 (1.1–9.2) 0.03

Other 0.4 (0.09–2.1) 0.31

Number of Patients Seen per Week

>= 50 / week Ref — —

<50 / week 2.2 (1.2–3.9) <.01

Conduct Female Sexual History

Infrequently (Rarely/Sometimes) Ref — —

Frequently (Usually/Always) 3.5 (1.8–6.8) <.0005

Diagnosed CT or GC in past year

No Ref — —

Yes 4.7 (2.5–9.1) <.0001

Knowledge of Reporting LawsIs this STD Reportable by Law?

n N (%)

Gonorrhea 315 429 (73)

Chlamydia 264 421 (63)

Primary and Secondary Syphilis 387 428 (90)

Non-gonococcal urethritis (NGU) 106 403 (26)Lymphogranuloma venereum (LGV) 211 419 (50)Chancroid 202 422 (48)

Granuloma Inguinale 172 420 (41)

Hepatitis B 203 423 (48)

HIV infection (w/out AIDS) 335 424 (79)

AIDS 345 424 (81)

"Yes"

* Analysis limited to providers who reporting having diagnosed ≥ 1 case of gonorrhea, chlamydia, or P&S syphilis in the past 12 months

Self-Reported Proficiencies

Proficiency Level

Provider Practice n N (%)Taking an adult sexual history 117 572 (20)Explaining importance of partner notification 136 585 (23)Taking an adolescent sexual history 192 573 (34)Discussing emergency contraception 239 584 (41)Discussing adolescent sexual activity 242 575 (42)Discussing sexual health with LGBT 246 577 (43)Asking a patient to proivde names of sex partners 409 577 (71)Describing DOHMH partner notification services 431 572 (75)

Limited/Fair

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, MPHBureau of STD ControlNYC DOHMHT: 212-788-4428mrogers@health.nyc.gov