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Program Details


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Practice Type: Promising
Program Name: Promoting Adolescent Reproductive Health Project
Organization: Erie County Department of Health
Web site:
Overview: Chlamydia is the most frequently reported communicable disease in the United States. In 2008, persons under 25 years of age accounted for more than 75 percent of the reported Erie County chlamydia cases. Most chlamydia infections are identified by screening asymptomatic sexually active adolescent and young adult females. Annual chlamydia screening of sexually active females 25 years and younger is recommended by federal agencies and national medical professional organizations. CDC has identified increasing chlamydia screening as a priority activity. However, both local and national Health Care Effectivenss Data and Information Set (HEDIS) Chlamydia Screening quality assurance measures suggest that few of the eligible females are being tested. Our goal was to improve access to confidential adolescent sexual health care services. Our objectives were to improve providers’ chlamydia screening knowledge, attitudes, and practices for adolescent and young adult females in Erie County, and increase the proportion of sexually active females 25 years and younger who are tested for chlamydia. Anticipated outcomes in the year after intervention compared to the year prior to intervention are to increase in Western New York health plans’ Chlamydia Screening HEDIS rates; increase in proportion of Erie County adolescents who have access to confidential health care services; increased Erie County primary care providers and OBGYNs self-efficacy in offering adolescent confidential health care services.
Year Submitted: 2009
Responsiveness and Innovation: Chlamydia is the most frequently reported communicable disease in the United States. Although up to 80 percent of female chlamydia are asymptomatic, chlamydia infection can lead to pelvic inflammatory disease with increased risk of ectopic pregnancies, chronic pelvic pain, HIV infection, and infertility among infected females. Given shrinking public health dollars, health departments do not have the capacity to screen most sexually active females 25 years and younger in the community. According to CDC surveillance data, most chlamydia infections are diagnosed in females tested at community health care sites rather than STD clinics. However, Chlamydia Screening HEDIS data suggest that many sexually active females eligible for annual chlamydia screening are not tested. According to NYSDOH surveillance data, Erie County has one of the highest reported chlamydia rates in New York State, while according to Blue Cross Blue Shield of WNY, Erie County has one of the lowest chlamydia screening HEDIS rates in New York State. Discussions with local pediatric leadership reveals that providers do not feel they can offer confidential adolescent health care services, especially to patients who have commercial health care where an explanation of benefits is sent to the primary insured (usually a parent). We developed a tool kit and standardized messages to assist providers to overcome barriers to offering confidential adolescent sexual health care services, including chlamydia screening. We went to the highest volume primary care and OBGYN offices to provide on-site medical education sessions with information on chlamydia screening and tools to improve confidential, adolescent health care services delivery that were identified by local and national primary care provider groups. We discussed with office staff in their office how they can change their current office flow and practices to facilitate confidential services delivery. Academic detailing is an office-based, medical education intervention. Whereas “detailing” has traditionally been used by pharmaceutical companies to change providers’ practices, “academic detailing” has proved to be a successful public health strategy to improve provider’s antibiotic prescribing practices. We used academic detailing as an intervention to change Erie County health care providers’ chlamydia screening practices. We conducted a literature review and extensive networking and interviews of leaders in public health STD prevention. Academic detailing with a tool kit to improve confidential adolescent sexual health care services has never been implemented. Strategies to improve providers’ delivery of confidential adolescent health care services and chlamydia screening have included didactic educational sessions, such as grand rounds, on-line CME, and other continuing medical education events; mailing information to providers offices without in person follow up; writing articles in national and local medical professional organizations newsletters; intensive physician training; and a staff-model health maintenance organization rapid cycle quality improvement project. Our strategy includes disseminating a comprehensive tool kit with tools available in print and on CD-ROM as well as office-based, educational sessions to explain the tools and discuss how they can be used and what systems changes can be made to improve care in an interactive dialogue with office staff.
Agency and Community Roles: The Erie County Department of Health (ECDOH) developed the tool kit materials, folders, and the local tool kit dissemination strategy. The medical director performed the academic detailing intervention, that is, she made the office visits to present the tool kits and lead the office discussions. National adolescent medicine experts were consulted for tool kit development recommendations. Local primary care providers reviewed the tools and offered their recommendations. All three major local health plans and the New York State Department of Health (NYSDOH) endorsed the tool kit and cosigned letters to providers and placed their logos on the tool kit folders. One local health plan provided our project with a list of the top volume primary care and OBGYN offices and their physician chlamydia screening HEDIS rates to determine which offices to target for this intervention. The ECDOH medical director provided frequent didactic presentations to the local medical professional community, such as grand rounds, residency program lectures, professional society talks and was very active in the local medical specialty societies. ECDOH collaborated on other public health related projects with NYSDOH, with the local primary care medical professional organizations, and with the local health plans. The ECDOH has a good working relationship with our partners. We assisted our partners in their priority areas to foster a collaborative relationship to meet our collective goals of improving our community’s health.
Costs and Expenditures: Start up costs: $1,000 for development and printing tool kits. Implementation costs: $20/office visit (refreshments). In kind: Program director salary, support staff salary, local travel, data management and analysis.
Implementation: Chlamydia is the most frequently reported communicable disease in the United States. Although up to 80 percent of female chlamydia are asymptomatic, chlamydia infection can lead to pelvic inflammatory disease with increased risk of ectopic pregnancies, chronic pelvic pain, HIV infection, and infertility among infected females. Given shrinking public health dollars, health departments do not have the capacity to screen most sexually active females 25 years and younger in the community. According to CDC surveillance data, most chlamydia infections are diagnosed in females tested at community health care sites rather than STD clinics. However, Chlamydia Screening HEDIS data suggest that many sexually active females eligible for annual chlamydia screening are not tested. According to NYSDOH surveillance data, Erie County has one of the highest reported chlamydia rates in New York State, while according to Blue Cross Blue Shield of WNY, Erie County has one of the lowest chlamydia screening HEDIS rates in New York State. Discussions with local pediatric leadership reveals that providers do not feel they can offer confidential adolescent health care services, especially to patients who have commercial health care where an explanation of benefits is sent to the primary insured (usually a parent). We developed a tool kit and standardized messages to assist providers to overcome barriers to offering confidential adolescent sexual health care services, including chlamydia screening. We went to the highest volume primary care and OBGYN offices to provide on-site medical education sessions with information on chlamydia screening and tools to improve confidential, adolescent health care services delivery that were identified by local and national primary care provider groups. We discussed with office staff in their office how they can change their current office flow and practices to facilitate confidential services delivery. Academic detailing is an office-based, medical education intervention. Whereas “detailing” has traditionally been used by pharmaceutical companies to change providers’ practices, “academic detailing” has proved to be a successful public health strategy to improve provider’s antibiotic prescribing practices. We used academic detailing as an intervention to change Erie County health care providers’ chlamydia screening practices. We conducted a literature review and extensive networking and interviews of leaders in public health STD prevention. Academic detailing with a tool kit to improve confidential adolescent sexual health care services has never been implemented. Strategies to improve providers’ delivery of confidential adolescent health care services and chlamydia screening have included didactic educational sessions, such as grand rounds, on-line CME, and other continuing medical education events; mailing information to providers offices without in person follow up; writing articles in national and local medical professional organizations newsletters; intensive physician training; and a staff-model health maintenance organization rapid cycle quality improvement project. Our strategy includes disseminating a comprehensive tool kit with tools available in print and on CD-ROM as well as office-based, educational sessions to explain the tools and discuss how they can be used and what systems changes can be made to improve care in an interactive dialogue with office staff.
Sustainability: Local health plans are committed to this project’s success and continuation because they must improve their Chlamydia Screening HEDIS rates. Local primary care providers are engaged because their chlamydia screening HEDIS rates are being measured and reported back to them by the local health plans. Local health plans are developing a pay-for-performance intervention that may be an incentive for local providers to increase their Chlamydia Screening HEDIS rates. The ECDOH medical director who is the project lead is very involved with the local medical community. She will have opportunities to make office visits and give didactic presentations on this topic in the future to reinforce positive practices and offer guidance to offices that are struggling to make needed systems changes. Blue Cross and Blue Shield of Western New York calculates Chlamydia Screening HEDIS rates annually. These data can be made available to ECDOH for ongoing assessment of community provider practices.
Lessons Learned: Information was not provided in 2009

 

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