Providers' perceived barriers to sexually transmitted disease care in 2 large health maintenance organizations.
OBJECTIVE
To identify providers' perceived barriers to sexually transmitted disease (STD) care in 2 health plans and plan-, clinician-, and patient-level factors that were associated with these barriers in order to inform quality improvement interventions.


METHODS
Surveys were mailed to a stratified sample of 1000 physicians, physician assistants, and nurse practitioners at 2 large health plans in 1999-2000. Of the 743 (82%) providers who received questionnaires and responded, data were analyzed from 699 with complete specialty information.


RESULTS
Ninety-five percent of providers identified at least 1 barrier to STD care. The most commonly cited barriers in both plans related to insufficient time and staff to address STDs, to counsel patients or manage sex partners, to keep current with managing high-risk patients, and to monitor patient adherence to recommendations to abstain from sex or use condoms during treatment. Nurse practitioners and specialists in obstetrics and gynecology were more likely to cite these barriers. Providers in staff models were more likely to cite the most common patient-level barriers. Few cited barriers related to diagnostic and treatment services.


CONCLUSIONS
Interventions in health plans are necessary to address constraints related to time and staff performing STD related care, keeping current with managing high-risk patients, and supporting patient adherence to provider recommendations.
Mark
Hayley
H
Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland 21205, USA. hmark1@son.jhmi.edu
Irwin
Kathleen
K
Sternberg
Maya
M
Anderson
Lynda
L
Magid
David
D
Stiffman
Michael
M
D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003625:Data Collection; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D008875:Middle Aged; D008880:Midwifery; D009722:Nurse Practitioners; D010823:Physician Assistants; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy; D011795:Surveys and Questionnaires