# Presentation: 041588

## Assessing the Training Needs of Managed Care Providers:  Implications for STD Clinical Training Targeting this Hard-to-Reach 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 Training Centers (NNPTC) is a CDC funded group of regional centers dedicated to increasing the knowledge and skills of health professionals in the areas of sexual and reproductive health.

## NNPTC

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

## Targeting Managed Care Providers

- May lack adequate training in STD diagnosis and management
- Hard to recruit for training activities
- Quality improvement--HEDIS measure for chlamydia

## Methods

- 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  

- 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

## Results

- 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 Challenges:  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:  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:  Chlamydia

|  | 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:  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: Chlamydia Screening in Adolescents/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:  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:  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 Topics

- Boston:
- 		-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 Modalities

- Boston:
- 		-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 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

## Acknowledgements

- J 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