Comparison of adherence to chlamydia screening guidelines among Title X providers and non-Title X providers in the California Family Planning, Access, Care, and Treatment Program.
BACKGROUND
Annual chlamydia screening is recommended for adolescent and young adult females and targeted screening is recommended for women ≥26 years based on risk. Although screening levels have increased over time, adherence to these guidelines varies, with high levels of adherence among Title X family planning providers. However, previous studies of provider variation in screening rates have not adjusted for differences in clinic and client population characteristics.


METHODS
Administrative claims from the California Family Planning, Access, Care, and Treatment (Family PACT) program were used to (1) examine clinic and client sociodemographic characteristics by provider group-Title X-funded public sector, non-Title X public sector, and private sector providers, and (2) estimate age-specific screening and differences in rates by provider group during 2009.


RESULTS
Among 833 providers, Title X providers were more likely than non-Title X public sector providers and private sector providers to serve a higher client volume, a higher proportion of clients aged ≤25 years, and a higher proportion of African American clients. Non-Title X public providers were more likely to be located in rural areas, compared with Title X grantees and private sector providers. Title X providers had the largest absolute difference in screening rates for young females vs. older females (10.9%). Unadjusted screening rates for young clients were lower among non-Title X public sector providers (54%) compared with private sector and Title X providers (64% each). After controlling for provider group, urban location, client volume, and percent African American, private sector providers had higher screening rates than Title X and non-Title X public providers.


CONCLUSIONS
Screening rates for females were higher among private providers compared with Title X and non-Title X public providers. However, only Title X providers were more likely to adhere to screening guidelines through high screening rates for young females and low screening rates for older females.
Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, California 94804, USA. joan.chow@cdph.ca.gov
Joan M
JM
Chow
Heike Thiel
HT
de Bocanegra
Denis
D
Hulett
Hye-Youn
HY
Park
Philip
P
Darney
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002140:California; D016009:Chi-Square Distribution; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000208:ethnology / Q000628:therapy; D003430:Cross-Sectional Studies; D005193:Family Planning Services / Q000191:economics / Q000592:standards*; D005260:Female; D019983:Guideline Adherence; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence / Q000592:standards*; D006801:Humans; D008403:Mass Screening / Q000592:standards*; D015999:Multivariate Analysis; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D017149:Private Sector / Q000592:standards*; D011365:Professional Practice Location; D015397:Program Evaluation; D017150:Public Sector / Q000592:standards*; D012111:Residence Characteristics; D019035:Rural Health Services / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D019037:Urban Health Services / Q000706:statistics & numerical data