Racial/Ethnic Differences in Service Utilization Patterns and Mobility of Female Clients in the Region VIII Infertility Prevention Project, 1994-2007

Background: The Region VIII Infertility Prevention Project (IPP) provides chlamydia (CT) testing and treatment of women in family planning (FP), STD, Indian Health Service (IHS), and other program areas. A soundex system provides regionally-unique patient identifiers.

Objectives: To assess service utilization patterns across clinics and program areas (FP, STD, IHS) and to determine demographic variations in utilization.

Methods: Analysis included female clients aged 10-19 who visited any FP clinic between 1994-2007. All records from visits to any IPP clinic were aggregated to the client-level (n=180,600), based on soundex and birthdate. Service utilization across program areas and clinics was assessed by age, race/ethnicity, year of first visit, and duration in IPP.

Results: Age at first visit varied by race/ethnicity: % of clients age<15 years ranged from 13% (whites) to 32% (American Indians). Racial/ethnic minorities were more likely to return to IPP clinics (range: 53% of American Indians to 34% of whites). Likelihood of visiting multiple programs increased for clients staying in IPP 2+ years, which was modified by race/ethnicity. Among returning clients (n=63,759), 82% of white clients exclusively visited FP clinics compared to 55% of black, 37% American Indian, 74% Asian, and 70% Hispanic clients. Likelihood of visiting an STD clinic was doubled for black clients compared to other racial/ethnic groups.

Conclusions: Racial/ethnic minorities remain IPP clients for a longer duration than white clients, but have greater mobility across programs. The ability to link client visit records across programs is necessary for accurate interpretation of service utilization and health outcomes.

Implications for Programs, Policy, and/or Research: Program capacity to monitor client utilization patterns of CT testing over time can assist IPP in developing targeted programs. Further research into reasons for client mobility could improve coordination of services between program areas.