Increasing Chlamydia and Gonorrhea Retesting Rates in a Student Health Center (SHC) Using a Quality Improvement Approach

Background: CDC recommends retesting all females and males approximately 3 months after treatment for chlamydia (CT) or gonorrhea (GC), or whenever they next seek medical care in the 12 months following initial treatment.  From May 2009 to May 2011, 16.5% (27/164) of students treated for CT/GC at University at Buffalo Student Health Services were retested within approximately 3 months (42-90 days).

Objectives: To monitor the impact of implementing a new process for increasing rates for test of reinfection (TOR) among students treated for CT/GC as part of a clinic-based quality improvement initiative.

Methods: Beginning August 2011, work flow, processes and staff roles/responsibilities were re-engineered under the Nurse Coordinator’s leadership: 1) Treatment – students with a positive CT/GC test result must see a provider to receive treatment (versus picking up a prescription only); medications are dispensed at no cost to student on site; 2) Letter – providers give students a standard letter with information about treatment and follow-up including TOR; students are advised that they will be contacted to return for TOR within 6 weeks; 3) Reminder – students receive a computer-generated TOR reminder from SHC and an individual email from the Nurse Coordinator 4-5 weeks after treatment; students who do not return also receive a phone reminder.  Each step is recorded in the electronic medical record (EMR) for process monitoring.

Results: From August to December, 2011, 21 students tested positive for CT (n=18) or GC (n=3).  Overall, 18 students (85.7%) returned for TOR, with an average elapsed time from treatment of 40 days (range: 25-47 days).

Conclusions: TOR rates increased dramatically (from 16.5% to 85.7%) in a university-based clinic following implementation of the Treatment-Letter-Reminder process.

Implications for Programs, Policy, and Research: Providers serving young adults should consider implementing system-level changes to increase the number of patients that return for TOR following treatment, along with systems to monitor retesting rates.