Region I IPP Clinic Staff and Provider Assessment Kim Watson, Jennifer Kawatu

Provider Assessment The primary goal is to inform the project around improvement of the regional IPP Performance measures – screening coverage and adherence to screening criteria. As a result of this assessment, the reasons for non-adherence to Chlamydia screening criteria at the provider level will be identified and possible opportunities for improvement can be proposed

Provider Assessment Step 1: KII’s conducted with 8 providers –Current practices –Why screen? –Awareness of regional screening criteria

Provider Assessment Preliminary findings from the key informant interviews indicate reasons for lack of adherence are: –unawareness of the screening criteria, –lack of buy-in, –poor documentation of risk factors?, –under-/ over-estimation of risk.

“I don’t know what the CDC ones are, but here we basically screen everybody. If somebody comes into the office, and cannot show me documented evidence of a negative CT screen in the past year, I will do a screening.” “For anyone coming in I offer it – I always ask if she’s interested in it – my clinical practice is to offer it to everyone regardless of age – and leave it up to them to decide.” Provider Assessment

Step 2: Survey –Web-based data collection –Invitation via FP partners and IPP AB representatives –Provider population –MA/and rest of states split up Provider Assessment

N=302 75%= Target audience - MD/NP,RN, FP/HIV Counselor 37% are MD/NPs 13% are RN/LPN 25% FP/HIV Counselors Provider Assessment

Type of Agency Family Planning Clinic 62% CHC15% STD Clinic10% Other12% (N=302 Responses)

State Participation

Provider Assessment Findings EMR Using/ Transitioning to EMR 30% Paper only70%

IPP or Not to IPP 34% IPP 26% Not IPP 38% Don’t Know Among MD/NP’s 40% didn’t know IPP project or not 33% of MD/NP and RN’s didn’t know

Provider Assessment - Results Chlamydia Screening - Practices Providers estimated that their clinic’s average Chlamydia positivity rate is 10.3%

Screening practices IPP

“I offer Chlamydia testing to everyone and leave it up to them to decide” True: 66% Overall 62% of IPP 79% of FP Clinic Representatives 73.4% of MD/NP Only’s “I screen everyone I can” True: 46% Overall 34% IPP 52% FP Clinic Representatives 52% MD/NP Only’s

Provider Assessment - Results Chlamydia Screening – CDC Recommendations Screen all sexually active females under 26 at least once a year and women over 26 who are at increased risk. No screening criteria for males Screen all sexually active males and females under 26 at least once a year and women and men over 26 who are at increased risk Screen all women of childbearing age and pregnant women

Provider Assessment - Results Provider’s Opinions on EPT 25% of responders currently practice EPT in their clinics

Source of Info re: CT screening General 10% hears from IPP rep 24% of those who know they are in IPP project hear from IPP rep – Clinic Specific 8% hears from IPP rep 21% of those who know they are in IPP say they hear from IPP rep -

Provider Assessment - Results Chlamydia Screening – Rescreening Practices Provider’s estimate… 50.3% of women treated for Chlamydia come back to be re- screened 10% of those re-screened are positive (although 40% estimate less than 3%)

Re-screening Practices “Ask patients to contact us and make appointment when re-screen time has arrived” –50% general –58% of FP representatives –67% of IPP “Yes” “Ask Pts. To come back for ‘Test of Cure’” –30% general –40% of MD/NP’s and RN’s –24% IPP “Yes”

Pregnancy Test Only TRUEFALSE Our policy is to screen all urine samples received for a pregnancy test (at least in women under 25) unless the patient declines. 39.5%60.5% Our policy is to offer screening of all urine samples received for pregnancy tests (at least in women under 25) and if they think they need it then we screen. 45.8%54.2% Our policy is not to differentiate between those under 25 and those over 25 in STD screening for Pregnancy Test “Only” Patients. 42.4%57.6%

Pregnancy Test Only TRUEFALSE Our policy is to only do Chlamydia testing during scheduled visits and annual exams. 24.3%75.7% I do not have time to do STD screening on walk-in Pregnancy Test “Only” visits. 9.3%90.7%

Next Steps: Further analysis of survey findings Send results to you by state, by? Focus groups (TBD) Performance Improvement Plan Questions? Ideas?