Hoover Karen, Tao Guoyu
Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Obstet Gynecol. 2008 May;111(5):1097-102. doi: 10.1097/AOG.0b013e31816bbe9b.
To identify missed opportunities for chlamydia screening in ambulatory care offices.
We analyzed data from the 2005 National Ambulatory Medical Care Survey to estimate the number of visits to obstetrician-gynecologists and primary care physicians (family and general practitioners, internists, and pediatricians) for preventive care, pelvic examinations, Pap tests, and urinalyses for nonpregnant women aged 15-25 years, and the proportion of these visits at which chlamydia tests were not performed.
Obstetrician-gynecologists provided care for nonpregnant women aged 15-25 years at 6.3 million office visits during 2005, and primary care physicians at 20.9 million visits. Although obstetrician-gynecologists conducted only 23.1% of visits made by young women, they conducted 68.8% of visits with pelvic examinations and 71.1% of visits with Pap tests. Primary care physicians conducted 77.5% of visits with urinalyses. Obstetrician-gynecologists did not perform a chlamydia test at 3.2 of 3.8 million (82.1%) visits with pelvic examinations and at 1.8 of 2.3 million (77.3%) visits with Pap tests. Primary care physicians did not perform a chlamydia test at 2.9 of 3.0 million (99.1%) visits with urinalyses.
There are many missed opportunities for chlamydia testing of young women in ambulatory care visits - during pelvic examinations, Pap tests, and urinalyses. Effective and simple interventions are needed to increase targeted chlamydia screening of women by physicians.
III.
确定门诊护理机构中衣原体筛查存在的漏诊情况。
我们分析了2005年全国门诊医疗护理调查的数据，以估算15至25岁非妊娠女性因预防性护理、盆腔检查、巴氏试验和尿液分析而就诊于妇产科医生和初级护理医生（家庭医生、全科医生、内科医生和儿科医生）的次数，以及这些就诊中未进行衣原体检测的比例。
2005年，妇产科医生为15至25岁非妊娠女性提供了630万次门诊护理，初级护理医生提供了2090万次。尽管妇产科医生仅进行了年轻女性就诊次数的23.1%，但他们进行了68.8%的盆腔检查就诊和71.1%的巴氏试验就诊。初级护理医生进行了77.5%的尿液分析就诊。在380万次盆腔检查就诊中，妇产科医生有320万次（82.1%）未进行衣原体检测；在230万次巴氏试验就诊中，有180万次（77.3%）未进行检测。在300万次尿液分析就诊中，初级护理医生有290万次（99.1%）未进行衣原体检测。
在门诊护理就诊期间，即盆腔检查、巴氏试验和尿液分析过程中，年轻女性衣原体检测存在许多漏诊情况。需要采取有效且简单的干预措施，以增加医生对女性进行针对性衣原体筛查的比例。
III级
