Gaps in Chlamydia Treatment Within California Family Planning Clinics: Are Patients Filling Prescriptions?

BACKGROUND: Compared with receiving medication dispensed in a health center, patients receiving prescriptions must take additional steps for treatment. Few clinics have protocols for ensuring prescriptions are filled. This study evaluated prescription fill rates for chlamydia treatment based on claims data in California Title X clinics and examined fill rates by patient demographics and clinic type. METHODS: We collected treatment information during Title X site audits for a convenience sample of patients with a positive chlamydia test between January 2008 and March 2013. We categorized patients as receiving treatment on-site versus via prescription and matched prescriptions to pharmacy billing claims within 90 days of test date. We examined treatment rates by patient age, gender, and race/ethnicity, and by clinic type, and assessed the median time to treatment. RESULTS: Among 790 patients diagnosed with chlamydia across 79 clinics, 65% (n = 513) were treated on-site and 33% (n = 260) via prescription; 17 (2%) did not have treatment information. Sixty-seven percent of prescriptions had confirmed receipt of treatment. Prescription fill rates were lower for patients age 18 years and younger (47% vs. 71%, P < 0.01) and for patients attending federally qualified health centers compared with stand-alone family planning clinics (63% vs. 88%, P < 0.01). Median time to treatment was similar for patients treated on-site (5 days) or via prescription (4 days). CONCLUSIONS: Delays in chlamydia treatment increase risk of complications and ongoing transmission. Providing medications on-site can improve treatment rates, especially among younger patients. These insights can inform clinic treatment protocols and efforts to improve quality of chlamydia care.

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.

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.