Improving Sexually Transmitted Infection Screening in Primary Care
Statement of Problem
While sexually transmitted infections (STIs) are common across people’s lifespans, they are particularly prolific in the adolescent population. About half of all new STIs reported each year are among young people between the ages of 15 to 24. If left untreated, these conditions have the potential to impact not only an individual’s health, but that of their partners’. Despite the availability of treatment, adolescents’ sexual health needs often go because of a reluctance to discuss them with a health care provider or lack of awareness that they are infected.
One important way to expand access to STI treatment is to routinely screen adolescents in primary care practices. For example, annual screening for chlamydia can lead to a 30-50 percent reduction in the incidence of pelvic inflammatory disease, which is common in patients with chlamydia. Currently, the American Academy of Pediatrics, the U.S. Preventative Services Task Force, and the American College of Obstetrics and Gynecology all recommend annual chlamydia screening of sexually active young women, however compliance with this recommendation is low. Screening for sexual health conditions is just as important as a physical or vaccination, so incorporating it into standard procedure for a well-visit is a logical step to promote adolescent health.
Since 2014, our team has engaged in continuous quality improvement to increase chlamydia screening for adolescent girls and young women in primary care. In order to improve screening rates, we obtain a urine sample from all adolescent and young adult females at primary care visits. When a patient screens positive, they return to clinic for treatment, where they receive sexual health education and resources to prevent future STIs.
We first implemented this project at the Karabots Care Network clinic, a West Philadelphia-based primary care practice within Children’s Hospital of Philadelphia’s (CHOP) network. Taking the information we gathered from Karabots, in 2017 we implemented this same project at another primary care site, the Cobbs Creek Care Network Clinic. We fine-tuned the screening process to best meet the needs of the patient and health care provider populations at this site, as both are distinct from our initial site. In addition to conducting these screens, we are also evaluating the efficacy of our processes and modifying them based on those results.
Since we began the intervention, we have seen a greater than 10 percent increase in chlamydia screening for adolescent girls and young women at both clinics, which means that more patients are receiving care, education and access to sexual health preventative services.
Both clinics serve a large population of West Philadelphia’s teens, who are seen by both are our adolescent medicine providers for family planning services and our primary care pediatricians for routine well care. In addition, these practices are located in low-income, minority communities, which are particularly vulnerable to STI transmission. Both of these factors make these locations prime opportunities to deliver STI screening, and we ultimately hope to learn the best processes to improve screening and treatment for STIs across a diverse array of clinical settings.
We will continue to evaluate and refine our universal urine collection process and conduct a formal data analysis. The hope is that moving forward, this intervention can inform how we deliver STI screening in primary care practices across the network. The data will also hopefully allow us to better understand the sexual health needs of the patients we serve and inform policy and practice solutions that help them transition into healthy, productive adults.