DO URINE TESTS INCREASE CHLAMYDIA SCREENING IN TEENS

尿液检测可以增加青少年的衣原体筛查吗

• 批准号: 6080583
• 负责人: MARY-ANN SHAFER
• 金额: $ 52.02万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-09-30 至 2002-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6080583
• 关键词: Chlamydia trachomatis; adolescence (12-20); clinical research; health care policy; health science research analysis /evaluation; health services research tag; human subject; nurse patient relations; nurses; nursing intervention; sex behavior; urinalysis

Sexually transmitted diseases (STDs) remain epidemic among sexually active adolescents. Addressing the problem within a primary care setting has been hindered by a number of barriers including the lack of screening for sexual activity and STD risk by the physician and by the lack of an accurate non-invasive screening test for C. trachomatis (CT) and N.gonorrhoeae (GC) and. Recently the nucleic acid amplification tests (NAATs) for CT and GC have been successfully applied to first void urines thereby obviating the need for traditional invasive screening (pelvic exam in females, urethral swab in males), yet the adoption of this technique for screening has been slow. To determine whether a "systems-level" intervention based on the Precede-Proceed model and targeting and training designated intake clinic nurses (intervention) results in an increased rate of urine-based screening for CT and GC in asymptomatic sexually active adolescents attending general HMO pediatric practice clinics compared to the traditional physician initiated screening model (control). Pediatric clinics caring for teens in a large regional HMO will be the target. In this quasi-experimental design, 10 clinics (500 teens in each clinic) will be grouped into the 2 conditions: 5 into the intervention and 5 into the control. Intervention: A designated nurse/medical assistant (nurse/MA) in each clinic will receive 4 hours of training to properly ask teens about sexual activity and subsequently to obtain urines for STD screening among the sexually active. The nurse/MA will have ongoing supervision and support. Physicians in the same condition will receive 1.5 hour workshop on the importance of urine screening using the new NAATs in the sexually active teen to increase support of the nurse/MA role. Control: These clinics will remain in the traditional "physician initiated" STD screening model. Physicians will receive a 1 hour didactic lecture on STDs in teens and the technology of the new NAATs for screening for CT and GC. No other staff will be included. NAATs for CT and GC will be available to all clinics. Data sources will include number and percent of sexually active teens screened with urines in each clinic, and demographic data obtained from a central patient information computer data bank. Analysis will focus on a comparison of urine screening among sexually active teens in the control and intervention clinics adjusting for potential teen and clinic differences.

性传播疾病在性活跃的青少年中仍然流行。 在初级保健环境中解决这个问题受到许多障碍的阻碍，包括缺乏医生对性活动和性病风险的筛查，以及缺乏准确的非侵入性C筛查测试。沙眼衣原体（CT）和淋病奈瑟菌（GC）。最近，用于CT和GC的核酸扩增测试（NAAT）已成功地应用于首次排尿，从而避免了对传统侵入性筛查（女性的盆腔检查，男性的尿道拭子）的需要，但采用这种技术进行筛查一直很慢。确定基于Precede-Proceed模型的“系统级”干预以及针对和培训指定的门诊护士（干预）是否会导致在普通HMO儿科诊所就诊的无症状性活跃青少年中进行CT和GC尿液筛查的比例高于传统的医生启动的筛查模型（对照）。在一个大型地区HMO中照顾青少年的儿科诊所将成为目标。在这种准实验设计中，10个诊所（每个诊所500名青少年）将被分为两种情况：5个进入干预组，5个进入对照组。干预措施：每个诊所的一名指定护士/医疗助理（护士/MA）将接受4小时的培训，以适当地询问青少年的性活动情况，随后在性活跃的人群中获得用于性病筛查的尿液。 护士/MA将得到持续的监督和支持。 处于相同条件下的医生将接受1.5小时的研讨会，讨论在性活跃的青少年中使用新的NAAT进行尿液筛查的重要性，以增加对护士/MA角色的支持。 控制：这些诊所将保持传统的“医生发起”的性病筛查模式。 医生将接受一个小时的关于青少年性传播疾病和新的NAAT技术的CT和GC筛查的教学讲座。 不包括其他工作人员。 CT和GC的NAAT将提供给所有诊所。 数据来源将包括每个诊所用尿液筛查的性活跃青少年的数量和百分比，以及从中央患者信息计算机数据库获得的人口统计数据。 分析的重点是比较控制和干预诊所中性活跃青少年的尿液筛查，以调整潜在的青少年和诊所差异。