Patient-delivered partner therapy for chlamydial infections: practices, attitudes, and knowledge of california family planning providers.

BACKGROUND: Treatment of sex partners is a core strategy for the control of chlamydia. Innovations such as patient-delivered partner therapy (PDPT) are effective in preventing repeat chlamydial infections, but providers' practice and perceptions of PDPT have not been adequately evaluated. This evaluation describes family planning providers' practices, knowledge, attitudes, and barriers regarding PDPT and assesses factors associated with routine use. METHODS: A cross-sectional, self-administered, Internet-based survey of a convenience sample of family planning providers in California was conducted in 2007. Multivariate logistic regression was used to determine predictors associated with routine PDPT use. RESULTS: Of the 286 respondents, 73% reported routinely using PDPT for chlamydia and 77% provided medication to clients for their partner(s). Providers were more likely to offer PDPT for female versus male clients (73% vs. 53%, P < 0.0001). More than 90% agreed that PDPT helped provide better care for clients, was well-received, and protected against reinfection. Common concerns about PDPT included missed counseling opportunities (51%) and incomplete care for partners (42%). Over one-third (41%) identified lack of reimbursement for PDPT as an important barrier to routine use. Independent predictors of routine PDPT use included affiliation with an agency that received free prepackaged single-dose medication for on-site PDPT dispensing (adjusted odds ratio = 2.66, 95% confidence interval: 1.39-5.10) and support of the clinic's medical director (adjusted odds ratio = 4.85, 95% confidence interval: 1.57-14.96). CONCLUSIONS: A majority of providers in this sample reported routinely using PDPT for chlamydia-infected clients; provision of prepackaged medication to clinics facilitated use of PDPT.

Group training programs and self-reported injury risk in female marathoners.

OBJECTIVE: To investigate the association of group training program (GTP) participation and other known risk factors with training and intrarace injury rates in female marathoners. DESIGN: Multivariate analysis of a self-reported questionnaire. SETTING: Nike Women's Marathon, San Francisco, CA. PARTICIPANTS: Three hundred seventy-eight female marathoners. MAIN OUTCOME MEASURES: Training and intrarace injury rates, severity of these injuries, and satisfaction rates. RESULTS: Participants of GTPs were 2.36 times more likely to experience intrarace injury than non-GTP participants (P = 0.02). Runners with mild and severe injuries in the past 12 months preceding training were 3.54 and 5.08 times more likely to be injured during training (P < 0.0001 and P < 0.0001), respectively, and those with previous severe injury were 6.43 times more likely to experience severe training injury (P < 0.0001). Similarly, the risk for intrarace marathon injury was 3.79 and 7.09 times greater among those with mild and severe injuries during training (P = 0.003 and P < 0.0001), and the risk of severe intrarace injury was 5.63 times greater for those reporting a severe training injury (P < 0.001). Runners with previous marathon experience had a 0.53 risk of severe training injury compared with inexperienced runners (P = 0.04). CONCLUSIONS: Participants of GTPs were more likely to be injured during the marathon in multivariate analysis but were also more satisfied with training in bivariate analysis. Female runners with previous injury had a greater risk of future training and race injury, and severe previous injury was associated with severe training and intrarace injury. Previous marathon experience was protective of severe training injury.

Retesting for repeat chlamydial infection: family planning provider knowledge, attitudes, and practices.

BACKGROUND: Repeated genital infections with Chlamydia trachomatis are common and associated with serious adverse reproductive sequelae in women such as infertility, ectopic pregnancy, and chronic pelvic pain. Retesting for repeat chlamydial infection is recommended 3 months after treatment for an initial infection; however, retesting rates in various settings are low. In order to design interventions to increase retesting rates, understanding provider barriers and practices around retesting is crucial. Therefore, in this survey of family planning providers we sought to describe: (1) knowledge about retesting for chlamydia; (2) attitudes and barriers toward retesting; (3) practices currently utilized to ensure retesting, and predictors associated with their use. METHODS: We conducted a cross-sectional, self-administered, Internet-based survey of a convenience sample of family planning providers in California inquiring about strategies utilized to ensure retesting in their practice setting. High-intensity strategies included chart flagging, tickler (reminder) systems, follow-up appointments, and phone/mail reminders. RESULTS: Of 268 respondents, 82% of providers reported at least 1 barrier to retesting, and only 44% utilized high-intensity interventions to ensure that patients returned. Predictors associated with use of high-intensity interventions included existence of clinic-level retesting policies (OR 3.95, 95% CI 1.98-7.88), and perception of a high/moderate level of clinic priority toward retesting (OR 3.75, 95% CI 2.12-.6.63). CONCLUSION: Emphasizing the importance of retesting to providers through adoption of clinic policies will likely be an important component of a multimodal strategy to ensure that patients are retested and that provider/clinic staff take advantage of opportunities to retest patients. Innovative approaches such as home-based retesting with self-collected vaginal swabs and use of cost-effective technologies to generate patient reminders should also be considered.

Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey.

STUDY OBJECTIVE: We provide new descriptive epidemiology on the demography and quality of care of women who experience sexual assault. Two limited aspects of emergency department treatment received by women who have experienced sexual assault are examined: (1) administration of emergency contraception to prevent pregnancy and (2) screening and treatment for sexually transmitted diseases (STDs). METHODS: A nationally representative survey on the basis of 7 years of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) was analyzed. Estimates of mean numbers of patients treated and characteristics of patients are reported for administration of emergency contraception and compliance with STD guidelines. RESULTS: Analysis shows that the number of rapes per year reported in the NHAMCS data is highly consistent with the number of forcible rapes reported by the Federal Bureau of Investigation. Results show statistically significant differences in patients who receive screening on the basis of age and also suggest that the same difference exists for STD medications received. Accounting for differences in screening and medications by age does not completely explain why a large portion of the patients are neither screened nor receive STD medications. CONCLUSION: Women are not receiving the full complement of treatment, as suggested by the Centers for Disease Control and Prevention guidelines. Administration of emergency contraception is less frequent in the NHAMCS sample than in hospitals with a sexual assault treatment program that report administration of emergency contraception. It is important to assess care for patients experiencing sexual assault in a nationally representative sample to identify deficiencies in treatment and areas in need of improvement.