“You're Negative for Chlamydia…Again” (Repeat Screening for Chlamydia)

Background:
In an attempt to target Chlamydia screening dollars effectively, patients repeatedly screening negative for Chlamydia were identified as a potential source of dollars that could be redirected in more appropriate ways.

Objective:
To determine the reason patients are being repeatedly screened for Chlamydia
To assess if the dollars spent reflects the best use of resources.
To determine appropriate actions to focus resources spent on repeat screening.

Method:
Calendar year 2006 Infertility Prevention Project (IPP) data was analyzed to identify patients receiving repeat screening (defined as more than two negative tests in a twelve-month period). Chart audits were performed at the five facilities with the greatest numbers of repeat screeners to determine the initial and subsequent reasons for Chlamydia screening.

Result:
To date, approximately 88% (836/945) of charts have been reviewed. Fifteen percent (146 patients) had repeat tests that were deemed appropriate by reviewers. The top three reasons for repeat screening included: unresolved current symptoms (18.94% of patients), a visit through the site's STD clinic followed by an annual or initial exam (14.39%), and screening at annual or initial exam, and repeat screening at a visit to perform a repeat pap (11.75%). Together they represent 45.08% of all charts reviewed. It is estimated that 61% of repeat tests (757) were done unnecessarily, and could be avoided in future instances. This would represent a cost savings of $7,570 that could be re-directed to more appropriate uses.

Conclusion:
The majority of unnecessary repeat testing can be avoided through provider education.

Implications:
The Kansas IPP will revise screening criteria to reflect the need to perform routine screening only if the patient has not had a test at the facility in the previous year. Providers will be educated on the need to evaluate and/or refer patients to specialists when recurrent symptoms cannot be resolved.