Assessing the Training Needs of Assessing the Training Needs of Managed Care Providers: Managed Care Providers:

Implications for STD Clinical Implications for STD Clinical Training Targeting this Hard-to-Training Targeting this Hard-to-

Reach GroupReach Group by the Eastern Quadrant PTCs of the

National Network of Prevention Training Centers (NNPTC)

Presented by: Janine Walker Dyer, MPH

Clinical Training Coordinator, STD/HIV Prevention Training Center

of New England

Center for Health & Behavioral Training

The National Network of Prevention The National Network of Prevention Training Centers (NNPTC) is a CDC Training Centers (NNPTC) is a CDC

funded group of regional centers funded group of regional centers dedicated to increasing the knowledge dedicated to increasing the knowledge and skills of health professionals in the and skills of health professionals in the

areas of sexual and reproductive health.areas of sexual and reproductive health.

NNPTCNNPTC

Part I Training Centers: Ten centers provide clinical training

Part II Training Centers: Four centers provide behavioral and social interventions training

Part III Training Centers: Four centers provide partner services and program support training

Geographical quadrants

Eastern Quadrant PTCs collaborated Eastern Quadrant PTCs collaborated to assess the STD training needs of to assess the STD training needs of managed care providers related to managed care providers related to STD diagnostics use, screening STD diagnostics use, screening practices, patient counseling, and practices, patient counseling, and patient management issues to guide patient management issues to guide training activities in the Eastern training activities in the Eastern

Quadrant Quadrant

Targeting Managed Care Targeting Managed Care ProvidersProviders

May lack adequate training in STD diagnosis and management

Hard to recruit for training activitiesQuality improvement--HEDIS measure for

chlamydia

MethodsMethods

EQPTCs collaborated with Boston University School of Public Health to conduct the needs assessment

Managed care organizations in Boston (Region I), New York (Region II), and Baltimore (Region III) were chosen to participate

Pediatric, internal medicine, family practice, and OB/GYN physicians were selected to receive surveys

Methods Methods Clinicians were randomly selected among participating

organizations and randomly assigned Syphilis, Chlamydia, or Training needs assessment questionnaires

A total of 649 surveys were mailed to selected providers-Region I: 314 surveys (Harvard Vanguard

Medical Associates, Harvard Pilgrim Health Care)-Region II: 300 surveys (Health Plus)-Region III: 35 surveys (Baltimore Medical

Systems) Incentive varied by region

ResultsResults

A total of 294 surveys were completed and returned Overall response rate was 49.8% 93% of respondents were Medicaid managed care

providers Regional response rates:

-Region I: 47.8%-Region II: 49.4%-Region III: 68.5%

Patient Management Patient Management Challenges: SyphilisChallenges: Syphilis

Boston

n=40

NYC

n=45

Baltimore

n=8

Evaluation of a pediatric patient with a reactive syphilis serology: often or always a challenge

94% 42% 33%

Management of an HIV+ patient with reactive syphilis serology: often or always a challenge

71% 45% 57%

Screening Practices: SyphilisScreening Practices: Syphilis

Boston

n=40

NYC

n=45

Baltimore

n=8

MSM at least annually

55% 78% 88%

Sex workers at least annually

55% 95% 100%

All HIV+ patients at least annually

48% 90% 75%

Women during first prenatal visit

81% 92% 83%

Screening Practices: Screening Practices: ChlamydiaChlamydia

Boston

n=35

NYC

n=48

Baltimore

n=8

Rarely or sometimes screen sexually active females 12-19

64% 84% 43%

Rarely or sometimes screen sexually active males 12-19

78% 81% 71%

Rarely or sometimes screen sexually active females 20-24

52% 79% 25%

Rarely or sometimes screen sexually active males 20-24

70% 82% 75%

Key Findings: ChlamydiaKey Findings: Chlamydia“If nucleic acid amplification urine tests for Chlamydia were available, would it prompt you to screen more sexually active patients for Chlamydia?”

Boston

n=35

NYC

n=48

Baltimore

n=8

Females

12-24 yrs

42% 56% 88%

Males

12-24 yrs

45% 62% 88%

Logistic Regression Models: Logistic Regression Models: Chlamydia Screening in Chlamydia Screening in

Adolescents/Young AdultsAdolescents/Young Adults Female physicians are more likely than male

physicians to screen female patients for Chlamydia

Physician gender does not predict Chlamydia screening practices for male patients

Region of physician practice does not predict screening practices for Chlamydia

Average number of patients seen by physicians does not predict screening practices for Chlamydia

Key Findings: TrainingKey Findings: Training

Training questionnaires elicited providers’ attitudes towards receiving STD and HIV prevention training, desired STD/HIV prevention training topics, and preferred training modalities

Key Findings: TrainingKey Findings: Training

Provider attitudes toward training: Most providers believed that training specific to STD and HIV prevention would enhance their practice:

Region I: 62.5%

Region II: 54%

Region III: 84.5%

Most Desired Training TopicsMost Desired Training TopicsBoston:

-New STD diagnostic techniques-Behavioral counseling models-Partner management

NYC:-CDC STD Treatment Guidelines-STD/HIV/AIDS reporting laws-Partner management

Baltimore:-New STD diagnostic techniques-Behavioral counseling models-Partner management

Preferred Training ModalitiesPreferred Training ModalitiesBoston:

-Full or half-day update conference-Grand Rounds-Self-study programs: web-based/internet

NYC:-Full or half-day update conference-Grand Rounds-Self-study programs: CD rom

Baltimore:-Full or half-day update conference-Grand Rounds-Self-study programs: CD rom

Next StepsNext Steps Share our findings with managed care stakeholders Integrate identified practice challenges, screening issues

and training needs into PTC clinical training courses Continue to incorporate CDC recommendations and

reports into STD/HIV/AIDS training content Promote access to urine-based screening Widely disseminate Eastern Quadrant training module

“Prevention and Management of STDs in Persons Living with HIV/AIDS” to HIV care providers

Link with CDC Advancing HIV Prevention initiative

AcknowledgementsAcknowledgementsJ Dyer1, S Ratelle1, T Cherneskie2, P Coury-Doniger3, T Hogan4, J Howland5, P McGrath3, S Minsky5, S Payette6, A Rompalo7, R Shnekendorf2

 

1Division of STD Prevention, Massachusetts Department of Public Health, Boston, MA; 2New York City Department of Health and Mental Hygiene, New York, NY; 3Center for Health and Behavioral Training, University of Rochester, Rochester, NY; 4Baltimore STD/HIV Prevention Training Center, Baltimore, MD; 5 Boston University School of Public Health, Boston, MA; 6New York State Department of Health, Albany, NY; 7Johns Hopkins School of Medicine, Baltimore, MD

The STD/HIV Prevention Training Centers are funded by Centers for Disease Control and Prevention