Assessing the Training Needs of Managed Care Providers: Implications for STD Clinical Training Targe

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Assessing the Training Needs of Managed Care
Providers Implications for STD Clinical
Training Targeting this Hard-to-Reach Group

• by the Eastern Quadrant PTCs of the National
  Network of Prevention Training Centers (NNPTC)
• Presented by Janine Walker Dyer, MPH
• Clinical Training Coordinator, STD/HIV Prevention
  Training Center
• of New England

Center for Health Behavioral Training
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The National Network of Prevention Training
Centers (NNPTC) is a CDC funded group of regional
centers dedicated to increasing the knowledge and
skills of health professionals in the areas of
sexual and reproductive health.
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NNPTC

• Part I Training Centers Ten centers provide
  clinical training
• Part II Training Centers Four centers provide
  behavioral and social interventions training
• Part III Training Centers Four centers provide
  partner services and program support training
• Geographical quadrants

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Eastern Quadrant PTCs collaborated to assess the
STD training needs of managed care providers
related to STD diagnostics use, screening
practices, patient counseling, and patient
management issues to guide training activities in
the Eastern Quadrant
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Targeting Managed Care Providers

• May lack adequate training in STD diagnosis and
  management
• Hard to recruit for training activities
• Quality improvement--HEDIS measure for chlamydia

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Methods

• EQPTCs collaborated with Boston University School
  of Public Health to conduct the needs assessment
• Managed care organizations in Boston (Region I),
  New York (Region II), and Baltimore (Region III)
  were chosen to participate
• Pediatric, internal medicine, family practice,
  and OB/GYN physicians were selected to receive
  surveys

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Methods

• Clinicians were randomly selected among
  participating organizations and randomly assigned
  Syphilis, Chlamydia, or Training needs assessment
  questionnaires
• A total of 649 surveys were mailed to selected
  providers
• -Region I 314 surveys (Harvard Vanguard
  Medical Associates, Harvard Pilgrim Health Care)
• -Region II 300 surveys (Health Plus)
• -Region III 35 surveys (Baltimore Medical
  Systems)
• Incentive varied by region

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Results

• A total of 294 surveys were completed and
  returned
• Overall response rate was 49.8
• 93 of respondents were Medicaid managed care
  providers
• Regional response rates
• -Region I 47.8
• -Region II 49.4
• -Region III 68.5

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Patient Management Challenges Syphilis

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Screening Practices Syphilis
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Screening Practices Chlamydia
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Key Findings Chlamydia
If nucleic acid amplification urine tests for
Chlamydia were available, would it prompt you to
screen more sexually active patients for
Chlamydia?
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Logistic Regression Models Chlamydia Screening
in Adolescents/Young Adults

• Female physicians are more likely than male
  physicians to screen female patients for
  Chlamydia
• Physician gender does not predict Chlamydia
  screening practices for male patients
• Region of physician practice does not predict
  screening practices for Chlamydia
• Average number of patients seen by physicians
  does not predict screening practices for
  Chlamydia

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Key Findings Training

• Training questionnaires elicited providers
  attitudes towards receiving STD and HIV
  prevention training, desired STD/HIV prevention
  training topics, and preferred training modalities

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Key Findings Training

• Provider attitudes toward training Most
  providers believed that training specific to STD
  and HIV prevention would enhance their practice
• Region I 62.5
• Region II 54
• Region III 84.5

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Most Desired Training Topics

• Boston
• -New STD diagnostic techniques
• -Behavioral counseling models
• -Partner management
• NYC
• -CDC STD Treatment Guidelines
• -STD/HIV/AIDS reporting laws
• -Partner management
• Baltimore
• -New STD diagnostic techniques
• -Behavioral counseling models
• -Partner management

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Preferred Training Modalities

• Boston
• -Full or half-day update conference
• -Grand Rounds
• -Self-study programs web-based/internet
• NYC
• -Full or half-day update conference
• -Grand Rounds
• -Self-study programs CD rom
• Baltimore
• -Full or half-day update conference
• -Grand Rounds
• -Self-study programs CD rom

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Next Steps

• Share our findings with managed care stakeholders
• Integrate identified practice challenges,
  screening issues and training needs into PTC
  clinical training courses
• Continue to incorporate CDC recommendations and
  reports into STD/HIV/AIDS training content
• Promote access to urine-based screening
• Widely disseminate Eastern Quadrant training
  module Prevention and Management of STDs in
  Persons Living with HIV/AIDS to HIV care
  providers
• Link with CDC Advancing HIV Prevention initiative

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Acknowledgements

• J Dyer1, S Ratelle1, T Cherneskie2, P
  Coury-Doniger3, T Hogan4, J Howland5, P McGrath3,
  S Minsky5, S Payette6, A Rompalo7, R Shnekendorf2
•  
• 1Division of STD Prevention, Massachusetts
  Department of Public Health, Boston, MA 2New
  York City Department of Health and Mental
  Hygiene, New York, NY 3Center for Health and
  Behavioral Training, University of Rochester,
  Rochester, NY 4Baltimore STD/HIV Prevention
  Training Center, Baltimore, MD 5 Boston
  University School of Public Health, Boston, MA
  6New York State Department of Health, Albany, NY
  7Johns Hopkins School of Medicine, Baltimore, MD
• The STD/HIV Prevention Training Centers are
  funded by Centers for Disease Control and
  Prevention