Increasing Chlamydia Screening in Primary Care by Creating An Adolescent Medical Home

Background: Many eligible adolescent females are not routinely chlamydia screened by primary care providers (PCPs) in their pediatric medical home.

Objectives: To increase PCP adolescent chlamydia screening by helping PCPs create an adolescent medical home.

Methods: PCPs in three pediatric offices were given protocol training and project tools.  Tools included (1) 16-question confidential risk behavior questionnaire with section to document PCP chlamydia testing; (2) letter to families explaining confidential adolescent services; and (3) teen-friendly web site brochure. PCPs were instructed to give all teens the questionnaire at annual exam and chlamydia test all sexually active (SA) females. The proportion of SA females chlamydia tested was measured for project weeks 1-10 and weeks 11-20. Pediatric offices received testing rates feedback for the two data collection periods and encouraged to adopt specific office systems changes to improve testing.

Results: During project weeks 1-10, 20% (20/99) and during weeks 11-20, 32% (15/47) of eligible females were chlamydia screened, although the proportion screened varied greatly by office (range:0-69%). After project week 20, all offices agreed to routinely collect urine specimens on all adolescent females at triage to improve testing. Office #1 initiated a formal chlamydia screening quality improvement project; Office #2 implemented a policy for nurses to chlamydia test all females >15 years, regardless of SA; Office #3 started chlamydia testing in office instead of referring to gynecologist. No office reported patient/parent dissatisfaction with routine screening.

Conclusions: To improve PCP chlamydia screening : (1) Need to frame chlamydia screening within context of current services delivered; (2) PCPs like “tools” to make change; (3) Systems changes are effective strategies to improve provider practices.

Implications for Programs, Policy, and Research: As health care reform changes service delivery systems, health departments can facilitate increased access to evidence-based STD screening by supporting quality improvement activities among community PCPs.