Barriers to screening sexually active adolescent women for chlamydia: a survey of primary care physicians.
OBJECTIVE
To determine the proportion of primary care physicians who screen sexually active teenage women for chlamydia and to determine demographic factors, practice characteristics, and attitudes associated with chlamydia screening.


METHODS
We obtained a random sample of 1600 Pennsylvania physicians from the American Medical Association masterfile, stratified to include at least 40% women and equal numbers of family physicians, internists, obstetricians/gynecologists, and pediatricians. In January 1998, physicians received mailed questionnaires; nonrespondents received two follow-up mailings. Physician characteristics associated with chlamydia screening were determined using bivariate and logistic regression analyses.


RESULTS
Only one-third of physicians responded that they would screen asymptomatic, sexually active teenage women for chlamydia during a routine gynecologic examination. In multivariate analysis, physicians were significantly (p <.05) more likely to screen if they were female (43% vs. 24%), worked in a clinic versus solo practice (60% vs. 18%), worked in a metropolitan location (46% vs. 26%), or had a patient population > or = 20% African-American (54% vs. 25%). Attitudes associated with screening included the belief that most 18-year-old women in their practice were sexually active (36% vs. 12%), feeling responsible for providing information about the prevention of sexually transmitted diseases to their patients (42% vs. 21%), or knowing that screening for chlamydia prevents pelvic inflammatory disease (37% vs. 13%). Physicians were less likely to screen if they believed that the prevalence of chlamydia was low (10% vs. 41%).


CONCLUSIONS
A majority of physicians do not adhere to recommended chlamydia screening practices for teenage women. Interventions to improve chlamydia screening might target physicians who are male, in private practice, or who practice in rural areas, and should focus on increasing awareness of the prevalence of chlamydia and benefits of screening.
Center for Research on Health Care and the Department of Medicine, the University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. cookrl@msx.upmc.edu
R L
RL
Cook
H C
HC
Wiesenfeld
M R
MR
Ashton
M A
MA
Krohn
T
T
Zamborsky
S H
SH
Scholle
D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002690:Chlamydia Infections / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D015999:Multivariate Analysis; D010414:Pennsylvania; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D012725:Sexual Behavior; D014932:Women's Health Services