A randomized trial of strategies to increase chlamydia screening in young women.
OBJECTIVE
Despite the recommendations of numerous clinical practice guidelines, testing of at-risk women for Chlamydia trachomatis infection remains low. We evaluated an intervention to increase guideline-recommended chlamydia screening.


METHODS
In a two-by-two factorial design randomized trial conducted in 2001-2002, 23 primary care clinics at Group Health Cooperative in Washington State were randomized to either control (standard) or intervention (enhanced) guideline implementation arms. Clinic-level intervention strategies included use of clinic-based opinion leaders, individual measurement and feedback, and exam room reminders. A second patient-level intervention, a chart prompt to screen for chlamydia, was delivered in a random sample of 3509 women. The outcome measure was post-intervention chlamydia testing rates among sexually active women ages 14-25.


RESULTS
The clinic-level intervention did not significantly affect overall chlamydia testing (odds ratio (OR) = 1.08, 95% confidence interval (CI) 0.92-1.26, P = 0.31). However, testing rates increased significantly among women making preventive care visits (OR, Pap test visit = 1.23, 95% CI, 1.01-1.51, P = 0.04; OR, physical exam visit = 1.22, 95% CI 1.06-1.42, P = 0.009, intervention vs. control clinics). The chart prompt intervention had no significant effect (OR = 1.08, 95% CI 0.94-1.23, P = 0.27).


CONCLUSIONS
Interventions to improve guideline-recommended chlamydia testing increased testing among women making preventive care visits. Additional organizational change and/or patient activation strategies may improve plan-wide testing, particularly among asymptomatic women.
Scholes
Delia
D
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA. scholes.d@ghc.org
Grothaus
Louis
L
McClure
Jennifer
J
Reid
Robert
R
Fishman
Paul
P
Sisk
Cynthia
C
Lindenbaum
Jeff E
JE
Green
Beverly
B
Grafton
Jane
J
Thompson
Robert S
RS
D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000517:prevention & control; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D006125:Group Practice, Prepaid / Q000592:standards*; D019983:Guideline Adherence; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine / Q000592:standards*; D011322:Primary Prevention / Q000592:standards*; D015397:Program Evaluation; D014861:Washington; D014932:Women's Health Services / Q000592:standards*