Providing Sexually Transmitted Disease Services: A Study on the Barriers to Screening, Reimbursement, and Collaboration According to Providers in Eastern North Carolina

Background:  Nearly 20 million new sexually transmitted diseases (STD) are reported in the U.S. each year resulting in health consequences to the patient; and a direct cost of nearly 16 billion dollars to the country.   Screening and treatment, reimbursement of STD services, and collaboration among health care entities are paramount to effective public health interventions.  The aim of this study is to determine perceived barriers to this effort.

Methods:  For this qualitative, descriptive study a member of the research team conducted semi-structured interviews with 133 staff members representing 2 emergency departments (ED), 13 federally qualified health centers (FQHC), and 25 local health departments (LHD) covering 33 counties in eastern North Carolina between September 1, 2015 to January 29, 2016.  Participants were asked about barriers to screening and treatment, coding/billing and reimbursement of STD services, and barriers to collaboration among these 3 entities (ED, FQHC, LHD).   A modification of Colaizzi’s procedural steps of analysis was used to extract, organize, and analyze the data for central themes.

Results:   Directors of Nursing comprised the largest portion of the sample (18%), followed by billing/coding supervisors (16.5%), and clinical services managers (13.5%).  Clinical providers (FNP, MD) comprised 6.8% of the sample.  Central themes emerged from the in-depth analysis within the 3 proposed questions on barriers.    First, barriers to screening included three themes:  limits to screening, insurance woes, and patient factors.  Unique to LHDs was the theme, “a culture of free”.  The second, barriers to reimbursement had two themes:  issues with coding, and insurance contracts.  The third, barriers to collaboration had three themes:  relationships, knowledge of other’s services, and time or system constraints.

Conclusions:  These themes provide a better understanding of barriers encountered by those working on the front lines.  Through increased knowledge, providers can increase their efforts in addressing these barriers and ultimately improving STD services.