Practitioner Education and Feedback to Decrease Ciprofloxacin Prescriptions in Patients with Acute Uncomplicated Cystitis.

CONTEXT: Current guidelines recommend a nonfluoroquinolone agent as first-line treatment of acute uncomplicated cystitis (AUC) because of concerns of antimicrobial resistance and adverse effects. OBJECTIVE: To test whether a multifaceted intervention involving education and feedback reduced primary care practitioners' ciprofloxacin prescriptions for AUC therapy. DESIGN: Primary care practitioners at 3 medical offices participated: 65 in the intervention group and 51 in the control group. Intervention group participants received an educational lecture and emailed summary of antimicrobial guidelines, their AUC prescriptions were audited, and feedback was provided on inappropriate antibiotic choices. Prescriptions at AUC encounters were tracked during baseline, intervention, and postintervention periods. MAIN OUTCOME MEASURES: Proportion of AUC encounters at which ciprofloxacin was prescribed vs recommended first-line antibiotics. RESULTS: Intervention group participants had 5262 eligible AUC encounters, and control group participants had 5473. At baseline, ciprofloxacin was prescribed at 29.7% and 33.7% of eligible AUC encounters in the intervention and control groups, respectively (p = 0.003). After intervention, ciprofloxacin was prescribed at 10.8% of eligible AUC encounters in the intervention group and 34.3% in the control (p < 0.001). Adjusted odds ratios of ciprofloxacin prescription for AUC therapy were significantly lower in the intervention group during postintervention and intervention periods vs baseline (0.29, 95% confidence interval = 0.20-0.44, p < 0.001 and 0.80, 95% confidence interval = 0.66-0.97, p = 0.03). Adjusted odds ratios did not change over time in the controls. CONCLUSION: Educating primary care practitioners and conducting audit and feedback reduced their prescriptions of ciprofloxacin for AUC therapy.

Evaluation of a Community Health Worker Intervention to Reduce HIV/AIDS Stigma and Increase HIV Testing Among Underserved Latinos in the Southwestern U.S.

OBJECTIVES: Latinos are at an elevated risk for HIV infection. Continued HIV/AIDS stigma presents barriers to HIV testing and affects the quality of life of HIV-positive individuals, yet few interventions addressing HIV/AIDS stigma have been developed for Latinos. METHODS: An intervention led by community health workers (promotores de salud, or promotores) targeting underserved Latinos in three southwestern U.S. communities was developed to decrease HIV/AIDS stigma and increase HIV knowledge and perception of risk. The intervention was led by HIV-positive and HIV-affected (i.e., those who have, or have had, a close family member or friend with HIV/AIDS) promotores, who delivered interactive group-based educational sessions to groups of Latinos in Spanish and English. To decrease stigma and motivate behavioral and attitudinal change, the educational sessions emphasized positive Latino cultural values and community assets. The participant pool comprised 579 Latino adults recruited in El Paso, Texas (n=204); San Ysidro, California (n=175); and Los Angeles, California (n=200). RESULTS: From pretest to posttest, HIV/AIDS stigma scores decreased significantly (p<0.001). Significant increases were observed in HIV/AIDS knowledge (p<0.001), willingness to discuss HIV/AIDS with one's sexual partner (p<0.001), and HIV risk perception (p=0.006). Willingness to test for HIV in the three months following the intervention did not increase. Women demonstrated a greater reduction in HIV/AIDS stigma scores when compared with their male counterparts, which may have been related to a greater increase in HIV/AIDS knowledge scores (p=0.016 and p=0.007, respectively). CONCLUSION: Promotores interventions to reduce HIV/AIDS stigma and increase HIV-related knowledge, perception of risk, and willingness to discuss sexual risk with partners show promise in reaching underserved Latino communities.

Women's experiences of and perspectives on abortion at public facilities in Mexico City three years following decriminalization.

OBJECTIVE: To understand the experiences of women undergoing legal first-trimester abortion through Mexico City's Ministry of Health (MOH) services. Aims included comparing satisfaction with medical and surgical abortion services; drawing evidence-based recommendations for program improvement; and measuring contraceptive uptake following abortion. METHODS: A total of 350 women completed a 65-item survey questionnaire at 2 main MOH abortion facilities. Moreover, a subset of 20 participated in an in-depth interview. Multivariate analysis was performed to investigate satisfaction with abortion care and in-depth interview (IDI) data were analyzed. RESULTS: The participants overwhelmingly reported satisfaction with the care they received, with no significant differences between the medical and surgical abortion groups. However, qualitative data revealed a need for a more sympathetic staff, reduced waiting times, more comprehensive information on surgical abortion, and counseling that includes psychosocial issues. Postabortion contraception uptake was high, with most women opting for the intrauterine device. CONCLUSION: The quantitative analysis suggests that although most women were satisfied with the services, some areas were identified as requiring improvement. The IDI data suggest that women wanted counseling to better address psychosocial needs and allow for discussion on a wider range of contraceptive methods.

Patient characteristics and service trends following abortion legalization in Mexico City, 2007-10.

Legal abortion services have been available in public and private health facilities in Mexico City since April 2007 for pregnancies of up to 12 weeks gestation. As of January 2011, more than 50,000 procedures have been performed by Ministry of Health hospitals and clinics. We researched trends in service users' characteristics, types of procedures performed, post-procedure complications, repeat abortions, and postabortion uptake of contraception in 15 designated hospitals from April 2007 to March 2010. The trend in procedures has been toward more medication and manual vacuum aspiration abortions and fewer done through dilation and curettage. Percentages of post-procedure complications and repeat abortions remain low (2.3 and 0.9 percent, respectively). Uptake of postabortion contraception has increased over time; 85 percent of women selected a method in 2009-10, compared with 73 percent in 2007-08. Our findings indicate that the Ministry of Health's program provides safe services that contribute to the prevention of repeat unintended pregnancies.

Linking cervical cancer to the human papillomavirus: findings from a qualitative study with Mexican women.

Cervical cancer is an important cause of mortality for women in developing countries. Researchers have established a link between cervical cancer and the human papillomavirus (HPV). We explored Mexican women's beliefs about cervical cancer and sexually transmitted infections (STIs), including HPV, to better understand the social implications of this linkage. We conducted eight focus groups with middle-aged and young women in Mexico City. Cervical cancer elicited different social and emotional responses than STIs; participants generally attached less culpability to it and saw it as more life threatening. Information campaigns should take into account differences in lay conceptions of these illnesses.

Cervical cancer and the HPV link: identifying areas for education in Mexico City's public hospitals.

OBJECTIVE: To assess Mexico City physicians' knowledge and practices regarding cervical cancer and human papillomavirus (HPV) to compare obstetricians/gynecologists (ob/gyns) and general practitioners (GPs) on these variables. MATERIAL AND METHODS: In April 2003, 187 ob/gyns and GPs working in 15 hospitals affiliated with the Federal District Secretary of Health (SSDF) completed a self-administered questionnaire. Pearson's chi-square tests were used to compare ob/ gyns and GPs on outcome variables. RESULTS: Nearly all providers (93%) identified HPV as the principal cause of cervical cancer. Ob/gyns had more detailed knowledge about HPV than GPs and were more likely to have heard of common oncogenic strains (p = .000). Sixteen percent of all physicians incorrectly stated that Pap tests should be performed every six months regardless of previous results, and 17% recommended hysterectomy as an option for treating mild or moderate dysplasia. CONCLUSIONS: While SSDF physicians had basic knowledge about the cervical cancer-HPV link, screening and management norms are priority areas for educational interventions.

Cervical cancer and the HPV link: identifying areas for education in Mexico City's public hospitals

OBJETIVO: Evaluar el conocimiento y las prácticas de los proveedores de servicios de salud en la Ciudad de México sobre el cáncer cervicouterino y el virus del papiloma humano (VPH); comparar a este respecto a ginecoobstetras (GO) y médicos generales (MG). MATERIAL Y MÉTODOS: En abril del 2003, 187 GO y MG empleados en 15 hospitales afiliados a la Secretaría de Salud del Distrito Federal (SSDF) completaron un cuestionario autoaplicado. Se utilizó la prueba de ji cuadrada de Pearson para evaluar las diferencias entre GO y MG. RESULTADOS: Casi todos los participantes (93%) identificaron el VPH como la causa principal del cáncer cervicouterino. Los GO mostraron un conocimiento más detallado del VPH que los MG, con más probabilidad de haber escuchado de las cepas oncogénicas comunes del VPH (p= 0.000). Un 16% de los médicos contestó incorrectamente que los exámenes de Papanicolaou deben realizarse cada seis meses y 17% recomendó la histerectomía como una opción de tratamiento para displasia leve o moderada. CONCLUSIONES: Los médicos que se desempeñan en el SSDF demostraron conocimiento básico acerca de la relación entre el cáncer cervicouterino y el VPH. Sin embargo, las normas relativas al tamizaje y manejo son áreas prioritarias para las intervenciones educativas dirigidas a esta población.

Do Mexico City pharmacy workers screen women for health risks when they sell oral contraceptive pills over-the-counter?

CONTEXT: In Mexico, oral contraceptives (OCs) are available to women over-the-counter in pharmacies. While past research has suggested that nonmedical providers, such as pharmacy workers, are capable of screening women for contraindications to OCs, little is known about their practices. METHODS: After selecting a 10% random sample of all pharmacies in Mexico City (n = 108), we surveyed the first available pharmacy worker to learn more about pharmacy workers' screening practices when selling OCs over-the-counter to women. RESULTS: While nearly all of the pharmacy workers surveyed had sold OCs without a prescription, only 31% reported asking women any questions before selling pills. Among those who asked questions, the most commonly asked questions were about other medications a woman was taking, about blood pressure and about alcohol intake. Pharmacy workers did not ask these questions consistently to all clients. CONCLUSION: Training pharmacy workers might be one strategy to improve screening of women for pill contraindications. However, pharmacy workers may lack the time and motivation to carry out such screening. An alternative strategy might be to better inform women to self-screen for pill contraindications.