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California data: many primary care providers who contract with Medicaid HMOs lag in STD screening.(Gynecology)
SAN FRANCISCO -- A significant proportion of primary care providers who contract with Medicaid HMOs don't follow recommended guidelines for screening and treating sexually transmitted diseases, Nadereh Pourat, Ph.D., said during the annual meeting of the American Public Health Association.
In 2002, 57% of Medicaid services in California (known as Medi-Cal) were provided through contracts with HMOs. The state's Department of Health Services and academic researchers surveyed 948 primary care physicians in the eight California counties with the highest rates of Medi-Cal patients and the highest rates of chlamydia and gonorrhea infection to assess whether clinicians adhered to guidelines for care.
Although 80% of the Medi-Cal HMOs involved in the study recommended annual chlamydia screening of 20- to 25-year-old females and of 15- to 19-year-old females, 62% of primary care physicians said that they screen annually for chlamydia in females aged 20-25 years, and 58% said that they screen females aged 15-19 years, said Dr. Pourat of the University of California, Los Angeles, Center for Health Policy Research.
Receiving a copy of HMO guidelines slightly improved screening rates by primary care physicians to 62% for females aged 20-25 years and 62% for females aged 15-19 years.
Screening rates were lower among physicians who contracted with HMOs that lacked these recommendations, she added.
Pediatricians or internists were less likely than ob.gyns, or general or family physicians to adhere to STD guidelines. Male physicians and those seeing a smaller volume of Medi-Cal patients followed STD guidelines less often than female physicians or those with more Medi-Cal patients.
Overall, 65% of primary care physicians surveyed were male.
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