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

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.

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

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

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

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

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

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%

Patient Management Challenges: Syphilis Boston n=40 NYC n=45 Baltimore n=8 Evaluation of a pediatric patient with a reactive syphilis serology: often or always a challenge 94%42%33% Management of an HIV+ patient with reactive syphilis serology: often or always a challenge 71%45%57%

Screening Practices: Syphilis Boston n=40 NYC n=45 Baltimore n=8 MSM at least annually 55%78%88% Sex workers at least annually 55%95%100% All HIV+ patients at least annually 48%90%75% Women during first prenatal visit 81%92%83%

Screening Practices: Chlamydia Boston n=35 NYC n=48 Baltimore n=8 Rarely or sometimes screen sexually active females %84%43% Rarely or sometimes screen sexually active males %81%71% Rarely or sometimes screen sexually active females %79%25% Rarely or sometimes screen sexually active males %82%75%

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?” Boston n=35 NYC n=48 Baltimore n=8 Females yrs 42%56%88% Males yrs 45%62%88%

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

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

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%

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

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

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

Acknowledgements J Dyer 1, S Ratelle 1, T Cherneskie 2, P Coury-Doniger 3, T Hogan 4, J Howland 5, P McGrath 3, S Minsky 5, S Payette 6, A Rompalo 7, R Shnekendorf 2 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