An Intervention to Improve Chlamydia and Gonorrhea Testing Among Adolescents in Primary Care

Abstract

Background and objectives: Rates of chlamydia and gonorrhea among adolescents continue to rise. We aimed to evaluate if a universal testing program for chlamydia and gonorrhea improved testing rates in an urban general pediatric clinic and an urban family medicine clinic within a system of federally qualified health care centers and evaluated the feasibility, cost, and logistic challenges of expanding implementation across 28 primary care clinics within a federally qualified health care centers system.

Methods: A universal testing quality improvement program for male and female patient 14 to 18 years old was implemented in a general pediatrics and family medicine clinic in Denver, Colorado. The intervention was evaluated by using a controlled pre-post quasi-experimental design. The difference in testing rates due to the intervention was assessed by using a difference-in-differences regression model weighted with the inverse probability of treatment.

Results: In total, 15 541 pediatric encounters and 5420 family medicine encounters were included in the analyses. In pediatrics, the unadjusted testing rates increased from 32.0% to 66.7% in the intervention group and from 20.9% to 28.9% in the comparison group. For family medicine, the rates increased from 38.5% to 49.9% in the intervention group and decreased from 26.3% to 24.8% in the comparison group. The intervention resulted in an adjusted increase in screening rates of 25.2% (P < .01) in pediatrics and 11.8% (P < .01) in family medicine. The intervention was well received and cost neutral to the clinic.

Conclusions: Universal testing for chlamydia and gonorrhea in primary care pediatrics and family medicine is a feasible approach to improving testing rates .

FIGURE 1

Time line of the universal gonorrhea and chlamydia intervention.

FIGURE 2

Percentage of encounters in which patients had gonorrhea and chlamydia testing completed in the pre- and postintervention periods by month. Raw data are represented by circles, whereas the adjusted model outcomes are shown with a solid line. Vertical lines denote the beginning of the intervention. A, Pediatric testing rates by month. The figure has 2 vertical lines, one denoting when the intervention was initially implemented for only female patients at the intervention clinic and the second for when the intervention was implemented for all patients. B, Family medicine testing rates by month.