title: Interventions to Improve Sexually Transmitted Disease Screening in Clinic-Based Settings.
abstract: BACKGROUND
  The asymptomatic nature and suboptimal screening rates of sexually transmitted diseases (STD) call for implementation of successful interventions to improve screening in community-based clinic settings with attention to cost and resources.
  
  
  METHODS
  We used MEDLINE to systematically review comparative analyses of interventions to improve STD (chlamydia, gonorrhea, or syphilis) screening or rescreening in clinic-based settings that were published between January 2000 and January 2014. Absolute differences in the percent of the target population screened between comparison groups or relative percent increase in the number of tests or patients tested were used to score the interventions as highly effective (>20% increase) or moderately effective (5%-19% increase) in improving screening. Published cost of the interventions was described where available and, when not available, was estimated.
  
  
  RESULTS
  Of the 4566 citations reviewed, 38 articles describing 42 interventions met the inclusion criteria. Of the 42 interventions, 16 (38.1%) were categorized as highly effective and 14 (33.3%) as moderately effective. Effective low-cost interventions (<$1000) included the strategic placement of specimen collection materials or automatic collection of STD specimens as part of a routine visit (7 highly effective and 1 moderately effective) and the use of electronic health records (EHRs; 3 highly effective and 4 moderately effective). Patient reminders for screening or rescreening (via text, telephone, and postcards) were highly effective (3) or moderately effective (2) and low or moderate cost (<$1001-10,000). Interventions with dedicated clinic staff to improve STD screening were highly effective (2) or moderately effective in improving STD screening (1) but high-cost ($10,001-$100,000).
  
  
  CONCLUSIONS
  Successful interventions include changing clinic flow to routinely collect specimens for testing, using EHR screening reminders, and reminding patients to get screened or rescreened. These strategies can be tailored to different clinic settings to improve screening at a low cost.
authors.affiliation: From the *Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; †Arizona Department of Health Services, STD Program, Phoenix, AZ; ‡STD Control Branch, Division of Communicable Disease Control (DCDC), Center for Infectious Diseases (CID), California Department of Public Health (CDPH), Sacramento, CA; and §Baltimore Department of Public Health, Baltimore, MD.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Taylor
authors.forename: Jessica
authors.initials: J
authors.lastname: Frasure-Williams
authors.forename: Phyllis
authors.initials: P
authors.lastname: Burnett
authors.forename: Ina U
authors.initials: IU
authors.lastname: Park
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D006293:Health Promotion; D006801:Humans; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000517:prevention & control*