Salomon Sarah Goldenkranz, Torrone Elizabeth, Nakatsukasa-Ono Wendy, Fine David N
From the *Foundation for Healthy Generations, Seattle, WA; †Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA; and ‡Cardea Services, Seattle, WA.
Sex Transm Dis. 2017 Sep;44(9):519-523. doi: 10.1097/OLQ.0000000000000641.
Annual chlamydia (CT) screening is recommended for women younger than 25 years, yet less than half of young women seeking health care are screened annually. We analyzed Title X family planning service data from the Northwest United States to assess factors associated with missed opportunities for CT screening. Our primary hypothesis was screening coverage is higher during annual preventive health visits compared to other visit types. Study objectives were: (1) identify gaps in screening coverage by patient demographics, visit characteristics, and clinic measures; and (2) examine the association between visit type and CT screening by controlling for other covariates and stratifying by state.
Calendar year 2011 Title X visit records (n = 180,856) were aggregated to the patient level (n = 112,926) to assess CT screening coverage by all characteristics. Screening variation was explored by bivariate and multivariate Poisson regression. Adjusted models for each state estimated association between comprehensive examination and screening controlling for confounders.
Clinic and visit characteristics were associated with CT screening. Coverage ranged from 45% in Washington to 80% in Alaska. Only 34% of patients visited for a routine comprehensive examination. Visit type was associated with screening; 75% of patients who had a comprehensive examination were screened versus 34% of those without a comprehensive examination (unadjusted PR, 2.18; 95% confidence interval, 2.16-2.21). The association between comprehensive examination and CT screening varied significantly by state (interaction term, P < 0.001).
Missed screening opportunities are common among women who access brief appointments for specific needs but do not seek routine preventive care, particularly in some states. Structural interventions may help address these systematically missed opportunities.
建议对25岁以下女性进行衣原体（CT）年度筛查，但寻求医疗保健的年轻女性中每年接受筛查的不到一半。我们分析了美国西北部第十类计划生育服务数据，以评估与衣原体筛查错失机会相关的因素。我们的主要假设是，与其他就诊类型相比，年度预防性健康检查期间的筛查覆盖率更高。研究目标是：（1）根据患者人口统计学、就诊特征和诊所措施确定筛查覆盖率的差距；（2）通过控制其他协变量并按州分层，研究就诊类型与衣原体筛查之间的关联。
将2011年日历年的第十类就诊记录（n = 180,856）汇总到患者层面（n = 112,926），以评估所有特征的衣原体筛查覆盖率。通过双变量和多变量泊松回归探讨筛查差异。每个州的调整模型估计了综合检查与控制混杂因素后的筛查之间的关联。
诊所和就诊特征与衣原体筛查相关。覆盖率从华盛顿州的45%到阿拉斯加州的80%不等。只有34%的患者进行了常规综合检查。就诊类型与筛查相关；进行综合检查的患者中有75%接受了筛查，而未进行综合检查的患者中这一比例为34%（未调整的PR，2.18；95%置信区间，2.16 - 2.21）。综合检查与衣原体筛查之间的关联因州而异（交互项，P < 0.001）。
在因特定需求而进行简短预约但未寻求常规预防性护理的女性中，错失筛查机会很常见，尤其是在某些州。结构性干预措施可能有助于解决这些系统性错失的机会。
