DO URINE TESTS INCREASE CHLAMYDIA SCREENING IN TEENS

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一问题受到许多障碍的阻碍，包括医生缺乏对性活动和性病风险的筛查，以及缺乏对沙眼衣原体（CT）和淋病奈瑟菌（GC）的准确的非侵入性筛查试验。近年来，CT和GC的核酸扩增试验（NAATs）已成功应用于首次空尿，从而避免了传统的侵入性筛查（女性盆腔检查，男性尿道拭子），但采用该技术进行筛查的速度较慢。与传统的医生发起的筛查模式（对照组）相比，基于“先行-继续”模式的“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基于尿液的CT和GC筛查率增加。在大型地区HMO中照顾青少年的儿科诊所将成为目标。在这个准实验设计中，10个诊所（每个诊所500名青少年）将被分为两组：5个为干预组，5个为对照组。干预：每个诊所的指定护士/医疗助理（护士/MA）将接受4小时的培训，以正确地询问青少年的性行为，并随后在性活跃人群中获取尿液进行性病筛查。护士/MA将持续监督和支持。在相同条件下的医生将接受1.5小时的研讨会，关于在性活跃的青少年中使用新的NAATs进行尿液筛查的重要性，以增加对护士/MA角色的支持。对照：这些诊所将保持传统的“医生发起”性病筛查模式。医生将接受1小时的关于青少年性传播疾病的教学讲座，以及用于CT和GC筛查的新型NAATs技术。不包括其他工作人员。所有诊所均可使用CT和GC的NAATs。数据来源将包括在每家诊所进行尿检的性活跃青少年的人数和百分比，以及从中央患者信息计算机数据库获得的人口统计数据。分析将集中在对照和干预诊所对性活跃青少年尿液筛查的比较上，以调整潜在的青少年和诊所差异。

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.