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

Provider AssessmentType of Agency

Family Planning Clinic

62%

CHC 15%

STD Clinic 10%

Other 12%

(N=302 Responses)

State Participation

0

5

10

15

20

25

30

CT RI MA NH VT ME

% Surveys n =302

Provider Assessment Findings EMR

Using/ Transitioning to EMR

30%

Paper only 70%

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 - ResultsChlamydia Screening - Practices

• Providers estimated that their clinic’s average Chlamydia positivity rate is 10.3%

0%

20%

40%

60%

80%

100%

Offers Screening toEveryone

Screen all Women<26

Screen all Men andWomen <26

Screen Men andWomen >26 w ith

Risk

Screen Everyonew/o Proof of

Negative Test in PastYearYes No

Screening practices IPP

0

1020

3040

5060

7080

90

Offer toeveryone

All Women<25/26

All men andwomen <26

Over 25/26with risk

I screeneveryone I

can

IPP

NON IPP

• “I offer Chlamydia testing to everyone and leave it up to them to decide”

True:66% Overall62% of IPP 79% of FP Clinic Representatives73.4% of MD/NP Only’s

“I screen everyone I can”True:46% Overall34% IPP52% FP Clinic Representatives52% MD/NP Only’s

Provider Assessment - ResultsChlamydia Screening – CDC Recommendations

45.27%

68.98%

45.04%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

True

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 - ResultsProvider’s Opinions on EPT

• 25% of responders currently practice EPT in their clinics

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Legal in Their State Puts Provider atRisk

Comfortable withEPT

Is Effective forTreating Partners

Agree Disagree Don't Know

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 Specific8% hears from IPP rep21% of those who know they are in IPP say

they hear from IPP rep -

Provider Assessment - ResultsChlamydia 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%)When Do You Ask Patients to be Re-screened

3-4 weeks post treatment

5-11 weeks post treatment

3-4 months post treatment

5-11 months post treatment

One year post treatment orat their next annual exam

I don’t ask them to comeback.

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 OnlyTRUE FALSE

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

TRUE FALSE

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?