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Women's Health

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Improvements are needed in screening of sexually active young women for chlamydia infection

The most common sexually transmitted disease (STD) in the United States is Chlamydia trachomatis infection, affecting about 4 million people at a yearly cost of $2.2 billion. Women with this infection can develop pelvic inflammatory disease, ectopic pregnancy (and related death), infertility, and chronic pelvic pain, and they may increase their risk of contracting the human immunodeficiency virus (HIV) that causes AIDS. Apparently, there is much room to improve chlamydia screening rates for sexually active young women, according to a recent study supported by the Agency for Healthcare Research and Quality (HS09473). The study involved four U.S. health plans. Even in the health plan with the best performance, less than half of sexually active young women received a chlamydia screening test.

In the year 2000, health insurance plans were asked to collect data on their rate of chlamydia screening of sexually active women aged 15 to 25 years, when this screening was added to other evaluative measures of the Health Plan Employer Data and Information Set (HEDIS). HEDIS is a standardized set of measures for evaluating quality of care in managed care health plans. Health plans had a year to improve their screening rates, and people involved in the development of HEDIS had time to fine-tune the measure before public release of results in HEDIS 2001, according to Rita Mangione-Smith, M.D., M.P.H., of the University of California, Los Angeles.

Dr. Mangione-Smith and her colleagues studied screening rates of 19,214 sexually active females (identified by records of pregnancy, treatment of other STDs, etc.) aged 15 to 25 years who were enrolled during 1997 in one of four major U.S. health plans and visited a health care provider during that year. There was considerable variation among the plans, and performance was generally low. Chlamydia screening rates for sexually active females in the plans ranged from 2 percent to 42 percent.

More details are in "Screening for chlamydia in adolescents and young women," by Dr. Mangione-Smith, Elizabeth A. McGlynn, Ph.D., and Liisa Hiatt, M.S., in the November 2000 Archives of Pediatric and Adolescent Medicine 154, pp. 1108-1113.

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