title: The role of Medicaid managed care interventions in Chlamydia screening by physicians.
abstract: BACKGROUND
  Chlamydia trachomatis (CT) guidelines call for annual screening of all sexually active young females. In previous studies, Medicaid health maintenance organizations (HMOs) did not consistently recommend CT and other sexually transmitted disease guidelines, but physicians with HMO practices were more likely to comply with guidelines than those without HMO practices. This study examines the relationship between HMO interventions and physician adherence to annual (CT) screening guidelines for sexually active young (ages 15-25) females.
  
  
  METHODS
  Medicaid HMOs (N = 17) of California were surveyed regarding their interventions to increase physician adherence with national CT screening guidelines in 2002. Primary care physicians (N = 941) who contracted with these HMOs were also surveyed on their frequency (always/usually) of CT screening. Data were analyzed using logistic regression models.
  
  
  RESULTS
  HMO-reported recommendations for CT screening and other interventions were associated with significantly higher odds of frequent CT screening by contracted physicians in unadjusted models. HMO recommendations to screen young females increased the odds of frequent CT screening, but other interventions were no longer significantly associated after controlling for physician characteristics. Physicians also had higher odds of reporting frequent CT screening if they had received training in the past, had received feedback from their contracted HMOs, or reported having access to national CT screening guidelines. Physician gender, specialty, years of clinical experience, and other factors were also significantly associated with the odds of frequency of CT screening.
  
  
  CONCLUSIONS
  Improving physician adherence with CT screening guidelines requires a refinement of current approaches with targeted interventions that are tailored to the characteristics of physicians. In addition, interventions are more likely to be effective if provided in formats that are perceived and acknowledged by physicians.
authors.affiliation: School of Public Health, University of California-Los Angeles, Los Angeles, CA 90024, USA. pourat@ucla.edu
authors.forename: Nadereh
authors.initials: N
authors.lastname: Pourat
authors.forename: Gerald F
authors.initials: GF
authors.lastname: Kominski
authors.forename: Jas
authors.initials: J
authors.lastname: Nihalani
authors.forename: Romni
authors.initials: R
authors.lastname: Neiman
authors.forename: Gail
authors.initials: G
authors.lastname: Bolan
mesh_terms: D000293:Adolescent; D000328:Adult; D002140:California; D002690:Chlamydia Infections / Q000175:diagnosis*; D002692:Chlamydia trachomatis / Q000302:isolation & purification*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations; D006801:Humans; D008403:Mass Screening / Q000592:standards* / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D010820:Physicians; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D014481:United States; D055815:Young Adult