Demographic Factors Associated with Foregoing of STD Care and - - PowerPoint PPT Presentation

Demographic Factors Associated with Foregoing of STD Care and Alternative Choices for Care if STD Clinics Were Not Available

William S. Pearson, PhD, MHA, FACE

AcademyHealth Annual Research Conference Boston, MA June 27, 2016

Disclaimer: The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division of STD Prevention

BACKGROUND

Epidemiology

• Chlamydia and Gonorrhea are the top two reported notifiable

diseases in the U.S.1

• In 2014 there were approximately 1.4 million reported cases of

chlamydia and 350,000 cases of gonorrhea.1

• These diseases lead to pelvic inflammatory disease and pregnancy

complications.2

• The presence of an STD can also increase the likelihood of

contracting HIV.2

Sources:

• 1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta: U.S. Department of

Health and Human Services; 2015

• 2. Workowski KA, Bolan G. Sexually Transmitted Disease Treatment Guidelines, 2015. MMWR Recomm Rep 2015; 64: 1-137.

BACKGROUND

• Health Services
• Estimated costs to the US healthcare system are $16

billion annually.1

• Treatment is relatively simple and inexpensive with the

use of antibiotics.2

• Follow-up and partner management are important

aspects of care.2

Sources:

• 1. Owusu-Edusei K, Chesson HW, Gift TL. The estimated direct medical cost of selected sexually transmitted

infections in the United States, 2008. Sex Trans Dis 2013; 40: 197-201.

• 2. Workowski KA, Bolan G. Sexually Transmitted Disease Treatment Guidelines, 2015. MMWR Recomm Rep 2015; 64:

1-137.

INTRODUCTION

STD clinics provide unique care. Expedited Partner Therapy (EPT) Disease Intervention Specialists (DIS) Study Question: Where would STD clinic patients go for STD care if STD clinics were not available?

Fun with surveys…

METHODS

Descriptive Study

• 2013 NACCHO Survey
• 19 questions
• Given to patients during sign-in at the clinic
• 21 STD clinics in 21 U.S. cities
• Selected based on prevalence of STDs within the MSA
• Clinics were eligible if they were categorical STD clinics
• Main purpose is to provide STD-related services at least 1 day per week and

were publically funded.

• 4,364 completed surveys

Seattle San Francisco Los Angeles Phoenix Minneapolis Detroit

• St. Louis

Memphis Dallas Houston San Antonio Atlanta Tampa Miami D.C. Baltimore Philadelphia New York Chicago Columbu s

21 STD clinics located in 21 U.S. cities

Cincinnati

Results

Demographics

Results

Demographics

Results

• Where would you have gone today if this STD clinic did not

exist? N = 4,364

• I would have waited to see how I felt

453, (10.4%)

• Hospital Emergency Room

692, (15.9%)

• Urgent Care Clinic

402, (9.2%)

• Community Health Center

528, (12.1%)

• Public Clinic

635, (14.6%)

• Family Planning Clinic

331, (7.6%)

• Private Doctor’s Office

718, (16.5%)

• Hospital Outpatient

67, (1.5%)

• School-based clinic

57, (1.3%)

• Some other place

299, (6.9%)

• Blank

182, (4.2%)

Results

Demographics, n = 453 Forgoing Care p* Male 9.5% .048 Female 11.3% White 11.3% NS Non-white 10.2% Employed 9.4% NS Other 10.8% More than H.S. 10.1% H.S. or less 10.7% > 27 Years 9.7% NS < 27 Years 11.2%

Results

Health Services, n = 453 Forgoing Care p* Insurance <.01 Insured 7.7% Not insured/Don’t Know 12.3% Private 8.1% NS Government 7.1% Parents’ 8.2% Usual Source for Care Usual source for routine care 7.8% <.01 No usual source for routine care 14.4% Usual source for sick care 8.0% <.01 No usual source for sick care 14.6%

Results

Logistic Regression*, n = 453 O.R. 95% C.I.

Sex Female 1.35 1.09-1.67 Male 1.00 1.00-1.00 Insurance None 1.40 1.11-1.77 Insured 1.00 1.00-1.00 Usual source of well care No 1.55 1.20-2.00 Yes 1.00 1.00-1.00 Usual source of sick care No 1.50 1.17-1.93 Yes 1.00 1.00-1.00

* Controlling for age, race, sex, insurance coverage, employment status, education, usual source of well and sick care

Discussion

Limitations Did not know the actual diagnosis and severity of each case Survey was not designed to be nationally representative Inherent response bias

Discussion

What is the value of specialized care? * ED costs for STDs are higher than in other settings.1 * STD clinics still play a role in providing specialized care.2, 3 * Stigma and cost are still issues in receiving STD

• treatment. 4

Is there a role for this type of care in the changing healthcare system?

Sources: 1.Owusu-Edusei K, et al. Does place of service matter? A utilization and cost analysis of STD infection testing. Sex Health 2016; Epub ahead of print.

• 2. Hoover KW, et al. Continuing need for STD clinics after the ACA. Am J Public Health 2015; 105:S690-S695.
• 3. Cramer R, et al. Are Safety Net Sexually Transmitted Disease Clinical and Preventive Services Still Needed in a Changing

Healthcare System? Sex Trans Disease 2014;10:628-630.

• 4. Pearson WS, et al. Willingness to use health insurance at an STD clinic. Am J Public Health. Published online ahead of print

June16, 2016.

Acknowledgements

Division of STD Prevention, Centers for Disease Control and Prevention

• Guoyu Tao, PhD
• Thomas Gift, PhD

NORC, University of Chicago

• Bradley Parsell, MS, MA

Questions?

For more information please contact Centers for Disease Control and Prevention William S. Pearson, wpearson@cdc.gov, 404-639-6459 1600 Clifton Road NE, Atlanta, GA 30333 Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348 Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Division Name in this space