region i ipp clinic staff and provider assessment kim watson, jennifer kawatu
TRANSCRIPT
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Region I IPP
Clinic Staff and Provider Assessment
Kim Watson, Jennifer Kawatu
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Provider Assessment
The primary goal is to inform the project around improvement of the regional IPP Performance measures – screening coverage and adherence to screening criteria.
As a result of this assessment, the reasons for non-adherence to Chlamydia screening criteria at the provider level will be identified and possible opportunities for improvement can be proposed
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Provider Assessment
• Step 1: KII’s conducted with 8 providers– Current practices– Why screen?– Awareness of regional screening criteria
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Provider Assessment
Preliminary findings from the key informant interviews indicate reasons for lack of adherence are: – unawareness of the screening criteria, – lack of buy-in, – poor documentation of risk factors?,– under-/ over-estimation of risk.
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“I don’t know what the CDC ones are, but here we basically screen everybody. If somebody comes into the office, and cannot show me documented evidence of a negative CT screen in the past year, I will do a screening.”
“For anyone coming in I offer it – I always ask if she’s interested in it – my clinical practice is to offer it to everyone regardless of age – and leave it up to them to decide.”
Provider Assessment
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Step 2: Survey – Web-based data collection– Invitation via FP partners and IPP AB
representatives– Provider population – MA/and rest of states split up
Provider Assessment
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• N=302
• 75%= Target audience - MD/NP,RN, FP/HIV Counselor
• 37% are MD/NPs
• 13% are RN/LPN
• 25% FP/HIV Counselors
Provider Assessment
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Provider AssessmentType of Agency
Family Planning Clinic
62%
CHC 15%
STD Clinic 10%
Other 12%
(N=302 Responses)
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State Participation
0
5
10
15
20
25
30
CT RI MA NH VT ME
% Surveys n =302
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Provider Assessment Findings EMR
Using/ Transitioning to EMR
30%
Paper only 70%
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IPP or Not to IPP
• 34% IPP
• 26% Not IPP
• 38% Don’t Know
• Among MD/NP’s 40% didn’t know IPP project or not
• 33% of MD/NP and RN’s didn’t know
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Provider Assessment - ResultsChlamydia Screening - Practices
• Providers estimated that their clinic’s average Chlamydia positivity rate is 10.3%
0%
20%
40%
60%
80%
100%
Offers Screening toEveryone
Screen all Women<26
Screen all Men andWomen <26
Screen Men andWomen >26 w ith
Risk
Screen Everyonew/o Proof of
Negative Test in PastYearYes No
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Screening practices IPP
0
1020
3040
5060
7080
90
Offer toeveryone
All Women<25/26
All men andwomen <26
Over 25/26with risk
I screeneveryone I
can
IPP
NON IPP
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• “I offer Chlamydia testing to everyone and leave it up to them to decide”
True:66% Overall62% of IPP 79% of FP Clinic Representatives73.4% of MD/NP Only’s
“I screen everyone I can”True:46% Overall34% IPP52% FP Clinic Representatives52% MD/NP Only’s
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Provider Assessment - ResultsChlamydia Screening – CDC Recommendations
45.27%
68.98%
45.04%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
True
Screen all sexually active females under 26 at least once a year and women over 26 who are
at increased risk. No screening criteria for
males
Screen all sexually active males and
females under 26 at least once a year and
women and men over 26 who are at increased
risk
Screen all women of childbearing age and
pregnant women
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Provider Assessment - ResultsProvider’s Opinions on EPT
• 25% of responders currently practice EPT in their clinics
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Legal in Their State Puts Provider atRisk
Comfortable withEPT
Is Effective forTreating Partners
Agree Disagree Don't Know
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Source of Info re: CT screening
General• 10% hears from IPP rep• 24% of those who know they are in IPP
project hear from IPP rep –
Clinic Specific8% hears from IPP rep21% of those who know they are in IPP say
they hear from IPP rep -
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Provider Assessment - ResultsChlamydia Screening – Rescreening Practices
Provider’s estimate…• 50.3% of women treated for Chlamydia come back to be re-
screened• 10% of those re-screened are positive (although 40% estimate
less than 3%)When Do You Ask Patients to be Re-screened
3-4 weeks post treatment
5-11 weeks post treatment
3-4 months post treatment
5-11 months post treatment
One year post treatment orat their next annual exam
I don’t ask them to comeback.
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Re-screening Practices
• “Ask patients to contact us and make appointment when re-screen time has arrived”– 50% general– 58% of FP representatives – 67% of IPP “Yes”
• “Ask Pts. To come back for ‘Test of Cure’”– 30% general– 40% of MD/NP’s and RN’s– 24% IPP “Yes”
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Pregnancy Test OnlyTRUE FALSE
Our policy is to screen all urine samples received for a pregnancy test (at least in women under 25) unless the patient declines.
39.5% 60.5%
Our policy is to offer screening of all urine samples received for pregnancy tests (at least in women under 25) and if they think they need it then we screen.
45.8% 54.2%
Our policy is not to differentiate between those under 25 and those over 25 in STD screening for Pregnancy Test “Only” Patients.
42.4% 57.6%
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Pregnancy Test Only
TRUE FALSE
Our policy is to only do Chlamydia testing during scheduled visits and annual exams.
24.3% 75.7%
I do not have time to do STD screening on walk-in Pregnancy Test “Only” visits.
9.3% 90.7%
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Next Steps:
• Further analysis of survey findings
• Send results to you by state, by?
• Focus groups (TBD)
• Performance Improvement Plan
Questions? Ideas?