Abstract
Study Objective
The purpose of this study was to evaluate whether providers offer chlamydia screening
to teenagers and/or whether screening is accepted at different rates depending on
insurance type.
Design
Retrospective chart review.
Setting
Academic center serving urban and suburban patients between April 2009 and October 2011.
Participants
Nine hundred eighty-three health maintenance visits for asymptomatic, insured female
adolescents aged 15-19 years.
Interventions
None.
Main Outcome Measures
Dichotomous dependent variables of interest indicated whether chlamydia screening
was: (1) offered; and (2) accepted. The key independent variable insurance type was
coded as ‘public’ if Medicaid or Medicaid Managed Care and ‘private’ if a commercial
plan. χ2 and logistic regression analyses were used to assess the significance of differences
in screening rates according to insurance type.
Results
Of asymptomatic health-maintenance visits 933 (95%) had a documented sexual history
and 339 (34%) had a documented history of sexual activity. After excluding those who
had a documented chlamydia screen in the 12 months before the visit (n = 79; 23%),
260 visits met eligibility for chlamydia screening. Only 169 (65%) of eligible visits
had chlamydia screening offered and there was no difference in offer of screening
according to insurance type. Significantly more visits covered by public insurance
had chlamydia screening accepted (98%) than those covered by private insurance (82%).
Controlling for demographic factors, the odds of accepted chlamydia screening was
8 times higher in visits covered by public insurance than those with private insurance.
Conclusion
Although publically and privately insured teens were equally likely to be offered
chlamydia screening, publically insured teens were significantly more likely to accept
screening. Future research should investigate reasons for this difference in screening
acceptance. These findings have implications for interventions to improve chlamydia
screening because more adolescents are covered by parental insurance under the Affordable
Care Act.
Key Words
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References
Centers for Disease Control and Prevention (CDC): 2013 Sexually Transmitted Disease Surveillance. Available: http://www.cdc.gov/std/stats13/exordium.htm. Accessed April 27, 2015.
- Grand rounds: chlamydia prevention: challenges and strategies for reducing disease burden and sequelae.MMWR Morb Mortal Wkly Rep. 2011; 60: 370
- Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2007; 147: 128
- Chlamydia screening among females aged 15–21 years — multiple data sources, United States, 1999–2010.MMWR Morb Mortal Wkly Rep. 2014; 63: 80
- Clinician adherence to recommendations for screening of adolescents for sexual activity and sexually transmitted infection/human immunodeficiency virus.J Pediatr. 2014; 165: 343
- Chlamydia screening among young women: individual- and provider-level differences in testing.Pediatrics. 2011; 127: e336
Centers for Disease Control and Prevention (CDC): Chlamydia screening percentages reported by commercial and Medicaid plans by state and year, 2011. Available: http://www.cdc.gov/std/chlamydia/female-enrollees-00-08.htm. Accessed April 29, 2015.
Article info
Publication history
Published online: June 19, 2015
Footnotes
The authors indicate no conflicts of interest.
Identification
Copyright
© 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
