Women's Health

Exam room reminders and physician feedback can improve screening for chlamydia in young women during preventive care visits

Genital Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease in the United States. Peak incidence occurs in sexually active adolescent and young adult women, in whom this often asymptomatic infection can cause pelvic inflammatory disease, tubal pregnancy, infertility, and chronic pelvic pain.

Despite recommendations to use a simple urine test to screen young sexually active women for chlamydia infection, screening rates remain low and the infection continues to be a major health problem. However, results from a randomized trial provide evidence that use of exam room screening reminders, physician opinion leaders, and screening measurement and feedback to physicians can improve chlamydia testing rates in women making preventive care visits.

The researchers randomized 23 primary care clinics in 1 managed care plan to either standard care or intervention (enhanced) care. Clinic-level intervention strategies included use of clinic-based opinion leaders, who educated clinicians on screening and counseling of young women; computerized reports that provided physicians with feedback on the proportion of eligible women screened by them, and exam room reminders to screen young women for chlamydia infection. The women were aged 14 to 25 years.

The clinic-level intervention did not significantly affect overall chlamydia testing. However, testing rates increased significantly for women making preventive care visits (by 23 percent for visits for Pap tests and by 22 percent for physical exam visits). The chart prompt to screen for chlamydia (delivered to a random subsample of women) had no significant effect. A combination of clinic-level change and patient activation strategies may improve health plan-wide testing, particularly among asymptomatic women, note the researchers.

The study was supported as part of the Translating Research into Practice initiative by the Agency for Healthcare Research and Quality (HS10514). More details are in "A randomized trial of strategies to increase chlamydia screening in young women," by Delia Scholes, Ph.D., Louis Grothaus, M.S., Jennifer McClure, Ph.D., and others, in Preventive Medicine 43, pp. 343-350, 2006.

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