DO URINE TESTS INCREASE CHLAMYDIA SCREENING IN TEENS

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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.