Background: Standard estimation of CT treatment compliance is based on chart review documentation of treatment, whether onsite or via prescription. Yet, it is unknown what percent of CT cases fill their prescriptions.
Methods: Treatment information was collected during routine Title X site audits for a convenience sample of Family Planning, Access, Care and Treatment Program clients with a CT-positive test from January 2008 through March 2013. Two treatment rates were calculated. The documented treatment rate (DTR) defined treated cases as all patients with treatment charted, whether onsite or via prescription. Prescriptions were then matched to billing claims within 90 days of test date to verify whether the prescription was filled. The verified treatment rate (VTR) defined treated cases as patients treated onsite or via a prescription validated with a matched billing claim. Rates were stratified by clinic type, age, and gender.
Results: Treatment information was analyzed for 795 cases across 85 Title X clinics. The DTR was 98%, with 514 (65%) patients treated onsite and 264 (33%) via prescription; 17 (2%) were untreated. Only 67% of prescriptions had matching billing claims, resulting in an 87% VTR. Among all treatment prescriptions, 97% occurred within community health centers (CHCs), which treated 49% of CT cases via prescription. The CHC-specific VTR was 82%, with a 63% prescription fill rate at federally-qualified health centers (FQHC), 58% at FQHC look-alikes, and 88% at other CHCs. Patients age <18 were significantly less likely to fill a prescription than patients >18 (47% versus 69%; p<0.01); there were no significant differences by gender.
Conclusions: Based on billing claims data, one-third of CT-positive patients treated via prescription in Title X settings did not fill their prescription, leading to an overestimation of chart-documented treatment rates. Offering medications onsite can improve CT treatment compliance, especially among younger patients.