STD Knowledge and Practices of New York City Providers

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STD Knowledge and Practices ofNew York City
Providers

• Meighan E. Rogers, MPH
• Bureau of STD Control, NYC DOHMH
• Region II IPP Meeting, May 31-June 1, 2006

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Background Proportion of Chlamydia and
Gonorrhea Cases Among Females 15-19, Reported
from Department of Health and Mental Hygiene
(DOHMH) Clinics, New York City, 2004
Gonorrhea
Chlamydia
8.1
11.5
91.9
88.5
Total N8656
Total N1723
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Background (cont)

• Screening recommendations (USPSTF)
• CT Routine for sexually active 15-25 year old
  females
• GC Sexually active women at risk (young,
  pregnant) no specific time period given

United States Preventive Services Task Force
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Background (cont)

• Population studies 35-74 of providers report
  annual CT screening
• Varies by provider type/specialty (74
  pediatricians 70 of NP 47 of primary care
  prov 35 of MDs nationally)
• Predictors of screening include female providers,
  adolescent med or ob/gyn specialty, practice in
  non-private setting, discussion of STD prevention
  with patients
• Knowledge of CT reporting requirement 50
  nationally

Guerry et al., 2005 Torkko et al., 2000 St.
Lawrence et al., 2002
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Objectives

• Among NYC providers
• Assess frequency of CT screening for female
  adolescents
• Assess predictors of CT screening for female
  adolescents
• Examine knowledge of reporting requirements
• Examine self-reported proficiencies in STD
  practice

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Methods I Sample

• Data Sources AMA Masterfile and proprietary
  database
• Criteria
• Providers who see patients at least 25 of time
• Specialties of internal medicine, ob/gyn,
  pediatrics, emergency med, family practice, adult
  health
• Surveys mailed to 2000 NYC providers November
  2004
• 1,600 MD/DOs, 200 NPs, and 200 PAs

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Methods II Measures

• Provider-level variables
• Provider type MD/DO, NP, PA
• Sex
• Race
• Practice setting (Inpatient, Ambulatory,
  Emergency)
• Specialty
• Practice-level variables (in past year)
• CT/GC diagnoses
• patients/week
• Frequency of performing sexual history for
  adolescent females
• Outcomes
• Frequency of CT screening
• Knowledge of reporting requirements
• Self-reported proficiency

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Methods III CT Screening Analysis

• Limited to providers who care for female
  adolescents
• Screening frequency - univariate and bivariate ?2
• Test of association btw screening and provider
  and practice-level variables bivariate ?2
• Independent predictors of provider CT/GC
  screening multivariate (MV) logistic regression

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Results
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Analytic Sample
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NYC Providers' Chlamydia and Gonorrhea Screening
Practices for Female Adolescents
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MV Predictors of CT Screening I
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MV Predictors of CT Screening II
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Knowledge of Reporting Laws
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Self-Reported Proficiencies
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Additional Findings

• Knowledge of CT reporting requirement differed
  significantly by specialty (plt.005)
• EM-82 PD-68 OB-65 IM-53
• Proficiency levels in different skill areas
  varied significantly by specialty
• OB and PD reported higher proficiency in taking
  an adolescent sexual history than IM, EM
• Highest interest in additional training re
  partner notification services available through
  DOHMH

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Conclusions

• Proportion of providers providing annual
  screening similar to previous surveys (54)
• Provider type (MD/DO, NP, PA) not significantly
  assoc with CT/GC screening
• Provider characteristics predict screening
  adherence
• Female providers
• Specialty type (OBG, FP, Pedfor GC)
• Frequently conducting a sexual history during
  routine visit
• Time constraints may be a factor providers
  reporting fewer patients more likely to screen
• Systems level interventions needed

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Conclusions (cont)

• Knowledge of reporting laws for CT not high (63)
  need to focus on IM, OB, PD
• Focus on increasing proficiency in taking
  adolescent sex history, talking about same sex
  issues
• Inform providers about DOHMH services

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Next Steps

• NYC BSTDC CT control strategic plan - 2005
• Development of a City Health Information
  publication on CT Summer 2006
• Begin public health detailing to promote and
  educate about screening guidelines integrate
  systems level changes
• Educate specialty groups through NYC Prevention
  Training Center (courses, grand rounds)

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Acknowledgments

• Bureau of STD Control, NYC DOHMH
• Contact Information
• Meighan Rogers, MPH
• Bureau of STD Control
• NYC DOHMH
• T 212-788-4428
• mrogers_at_health.nyc.gov