10. Knowledge and Use of Expedited Partner Therapy by a Sample of Pediatric Providers in the Treatment of Sexually Transmitted Infections

Abstract

screening overall and that privately insured women are screened at lower rates than those with public insurance. Desire for confidential services is known to be common among teenagers, and patient and provider assurance that CT testing can be done confidentially may vary by type of insurance coverage. To our knowledge, no published studies have evaluatedwhether screening is offered to or accepted by teens at different rates depending on insurance type. We analyzed the rates of CT screening of sexually experienced adolescent women presenting for annual physical. We hypothesized that rates of offering CT screeningwould be equal between sexually experienced teens with public vs. private insurance, but that those with private insurance would be more likely to decline screening. Methods: A retrospective chart review of all health maintenance visits by women ages 15–19 in an academic medical center serving urban and suburbanyouthbetweenApril 2009 andOctober 2011was conducted. De-identified data were extracted to document (i) whether chlamydia screening was offered; (ii) whether it was accepted, and if not, forwhat reason; and (iii) demographic data including insurance status and age. Public insurance was defined as Medicaid or Medicaid Managed Care Plan. Chi Square test was used to assess statistical significance of frequency differences in screening by insurance type. This study was approved by the IRB at Georgetown University Medical Center. Results: A total of 936 health maintenance visits were reviewed. One third (34%) of visits were made by patients with public insurance. History of sexual intercourse was documented in 399 (38%) of visits. After excluding visits with documented CT screening at a prior visit within 12 months (n 93) and those with STI symptoms (abdominal pain, vaginal discharge, dysuria/n 33), CT screening was offered to 54% of teens with reported history of sexual intercourse. Rates of offering screeningwere 49% for privately insured and 61% for publicly insured (p .06). Among teens whowere offered screening, rates of accepted screening were 83% for privately insured and 97% for publicly insured (p .01). Few providers documented reasons for offered screening being declined. Subgroup analysis by age demonstrated that differences in offering and accepting screening were more pronounced among younger (ages 15-17) comparedwith older (ages 18-19) teens. Conclusions: Adding to prior research, these findings suggest that differences in CT screening between publicly and privately insured teens are related both to differences in the likelihood of being offered screening by providers and the willingness of teens to undergo screening. Possible explanations for these findings include differential assurance of the confidentiality of testing and different perceptions of CT risk between publicly vs. privately insured teens and their providers. Sources of Support: None.