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New team approach dramatically boosts chlamydia screening of teenage girls

A team-oriented approach to testing for chlamydia increased the screening rate of sexually active 14- to 18-year-old female patients from 5 percent to 65 percent in a large California HMO, according to new study findings from researchers at the University of California, San Francisco, Department of Pediatrics and Kaiser Permanente of Northern California. The study was funded by the Agency for Healthcare Research and Quality (HS10537).

The approach consisted of organizing teams of nurses, doctors, medical assistants, and administrative staff at the HMO's pediatric clinics and educating them about chlamydia and its silent symptoms. Team members got buy-in from the HMO's leaders by presenting the gap between recommended screening practice and the plan's past performance; held monthly meetings to discuss problem-solving strategies; used urine-based testing instead of pelvic exams; and monitored progress with clinic-specific screening rates. The study authors noted that this new team-based screening system may help other managed care plans to improve detection of chlamydia infection and reduce the estimated $4 billion spent annually on its treatment.

Chlamydia is the most common bacterial sexually transmitted disease in the United States. Up to 15 percent of young women—one of every six—are estimated to have the disease, which if detected, can be treated easily with a single dose of antibiotics. If untreated, chlamydia can lead to pelvic inflammatory disease, infertility, and other serious health problems, including increased risk of HIV infection. Undetected chlamydial infections are responsible for the vast majority of tubal infertility cases in the United States.

Screening rates for chlamydia are low because many women don't have symptoms and don't like to get pelvic exams. The study authors note that the relatively new urine-based test makes pelvic exams unnecessary for detecting chlamydia, but the test is widely underused. In addition, some clinicians may feel uncomfortable asking young women, especially adolescents, about their sexual health or may not be trained in diagnosing chlamydia and providing appropriate followup care. The AHRQ-sponsored U.S. Preventive Services Task Force recommends routine screening for chlamydia for all sexually active women aged 25 and younger.

Select for the Task Force recommendation.

Lead study author Mary-Ann Shafer, M.D., a professor of pediatrics at the University of California, San Francisco, noted that the findings may help health plans and other types of medical practices increase their detection of chlamydia. Furthermore, the findings can be applied to other situations requiring an immediate change in practice, such as in response to a new infectious disease epidemic. These results underscore the importance of linking evidence-based information to specific strategies for care improvement.

For more information, see "The effect of a clinical practice improvement intervention on chlamydial screening among adolescent girls," by Dr. Shafer, Kathleen P. Tebb, Ph.D., Robert H. Pantell, M.D., and others, in the December 11, 2002, Journal of the American Medical Association 288(22), pp. 2846-2852.

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