1. STD Knowledge and Practices of New York City Providers Meighan E. Rogers, MPH Bureau of STD Control, NYC DOHMH Region II IPP Meeting, May 31-June 1, 2006

2. 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 Chlamydia Gonorrhea 8.1% 88.5% 91.9% 11.5% Total N=8656Total N=1723

3. 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

4. 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

5. 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

6. 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

7. 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

8. Methods III: CT Screening Analysis  Limited to providers who care for female adolescents  Screening frequency - univariate and bivariate χ 2  Test of association btw screening and provider and practice-level variables – bivariate χ 2  Independent predictors of provider CT/GC screening – multivariate (MV) logistic regression

9. Results

10. Analytic Sample No/Undeliverable: n = 353 (17.7%) No pt care in NYC: n = 73 (10.5%) Pt care in NYC: n = 622 (89.5%) Yes delivered: n = 1647 (82.3%) Respondents: n = 695 (42.2%) Surveys mailed to random sample of NYC providers: n = 2000 200NP 200PA 1600MD/DO† Delivered successfully ? Response received? Patient care in NYC? No pt care for adol. females: n=197 Conduct patient care for adol. females: n=425 (68.3%) Patient care for adolescent females? Non-Respondents: n = 952 (57.8%)

11. NYC Providers' Chlamydia and Gonorrhea Screening Practices for Female Adolescents

12. MV: Predictors of CT Screening I

13. MV: Predictors of CT Screening II

14. Knowledge of Reporting Laws

15. Self-Reported Proficiencies

16. Additional Findings  Knowledge of CT reporting requirement differed significantly by specialty (p<.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

17. 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, Ped–for 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

18. 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

19. 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)

20. Acknowledgments  Bureau of STD Control, NYC DOHMH  Contact Information: Meighan Rogers, MPH Bureau of STD Control NYC DOHMH T: 212-788-4428 mrogers@health.nyc.gov