Chlamydia screening and management practices of primary care physicians and nurse practitioners in California
Chlamydia screening and management practices of primary care physicians and nurse practitioners in California
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DOI：
10.1111/j.1525-1497.2005.00240.x
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发表时间：
2005-12-01
影响因子：
5.7
通讯作者：
Bolan, G
中科院分区：
文献类型：
--
作者：
Guerry, SL;Bauer, HM;Bolan, G
背景技术背景：由于性传播的衣原体感染在年轻女性中很常见，因此提供者对这些感染进行适当的筛查和管理是至关重要的。目的：评估加州初级保健医生和护士执业者的衣原体护理实践。设计：横断面，自我报告邮件调查。参与者：在加州，初级保健医生和初级保健执业护士的分层随机样本。调查内容包括5个主题领域：性史采集，宫颈炎的管理，非妊娠衣原体感染患者的管理，现场性病服务的可用性，衣原体筛查的做法和态度。主要结果测量是25岁及以下性活跃女性衣原体筛查的报告频率。受访者包括708名医生（49%的回应率）和895名执业护士（63%的回应率）。近一半的医生（47%，95%置信区间[CI]，42%至51%）和大多数执业护士（79%，95% CI，77%至82%）报告了20岁以下女性的常规衣原体筛查; 20至25岁女性的常规筛查比例相似。独立的预测因素筛选的医生是青少年医学专业，女性，在非私人环境中执业，并有较高的女性患者的数量。其他研究结果包括过度筛选25岁以上的妇女执业护士和供应商之间的共同关注，衣原体筛查可能不会recommended.CONCLUSIONS：衣原体的许多加州初级保健提供者的护理实践是不符合现行的指导方针。有针对性的提供者教育和改善偿还是潜在的改进战略。
BACKGROUND: Because sexually transmitted chlamydial infections are common among young women, it is critical that providers screen and manage these infections appropriately.OBJECTIVE: To assess the Chlamydia care practices of California primary care physicians and nurse practitioners.DESIGN: Cross-sectional, self-report mail survey.PARTICIPANTS: A stratified random sample of primary care physicians and a convenience sample of primary care nurse practitioners in California.MEASUREMENTS AND MAIN RESULTS: Survey content included 5 topic areas: sexual history taking, management of cervicitis, management of a nonpregnant Chlamydia-infected patient, availability of on-site STD services, and Chlamydia screening practices and attitudes. Main outcome measure was the reported frequency of Chlamydia screening of sexually active women age 25 and younger. Respondents included 708 physicians (49% response rate) and 895 nurse practitioners (63% response rate). Nearly half of physicians (47%, 95% confidence interval [CI], 42% to 51%) and a majority of nurse practitioners (79%, 95% CI, 77% to 82%) reported routine Chlamydia screening of women under age 20; similar proportions reported routinely screening women aged 20 to 25 years. Independent predictors of screening among physicians were adolescent medicine specialty, female gender, practicing in a nonprivate setting, and having a higher volume of female patients. Additional findings included the overscreening of women over age 25 by nurse practitioners and the shared concern among providers that Chlamydia screening may not be reimbursed.CONCLUSIONS: The Chlamydia care practices of many California primary care providers are inconsistent with current guidelines. Targeted provider education and improved reimbursements are potential strategies for improvement.