367 SCREENING TEENS FOR CHLAMYDIA DURING PEDIATRIC URGENT CARE: HOW CAN IT BE ACCOMPLISHED?

PurposeTo evaluate an intervention to increase CT screening among 14- to 18-year-old sexually active teens in HMO during pediatric urgent care visits. Chlamydia trachomatis (CT) is the most common reportable bacterial infection in teen girls. Most infections are asymptomatic and if untreated can lead to PID, ectopic pregnancy, and infertility. Despite at least annual screening recommendations for sexually active adolescents, little progress is being made. Of concern is the fact that that most (half to two-thirds) teens in any given year are never seen for a preventive health visit, where CT screening is more routine. Interventions are therefore needed to reach teens at their point of contact with the health care system-urgent care.MethodsIn a randomized control trial of 10 pediatric clinics, 5 clinics received a systems intervention in which a team of providers and clinic staff at each clinic established CT screening guidelines for urgent care. Teams were given a toolkit that had been used successfully in our prior well-care intervention. They met monthly to review protocols and screening rates and problem-solve barriers. Controls received a lecture on the importance of CT screening and were given the same intervention toolkit. CT screening rates between January 2005 and June 2006 were evaluated.ResultsPreliminary data indicate that improvements in CT screening rates among females in the intervention clinics were greater than improvements in the controls (+8.8% and −3.0% respectively). This difference approached significance, p = .058 (95% CI −0.2410, 0.0050). Two of the five intervention clinics have not adopted systems changes proven to be successful at the other clinics. With these two clinics excluded, mean improvement for the intervention clinics (14%) was significantly greater than controls (−3.0%), p = .021 (95% CI −0.3033, −0.0367). Baseline average for the intervention group was 32% and 47% at postintervention.ConclusionsThe most significant improvements in CT screening rates for girls occurred among clinics that adopted the intervention model and used recommended tools. It is necessary to pursue innovative interventions to increase screening in urgent care to reach the majority of at-risk teens.