Missed Opportunities for Chlamydia Screening in Women Aged 15-25

Background: Rates of Chlamydia screening in sexually-active women aged 15-25 are low nationally. Previous studies of missed testing opportunities used only single-year data.

Methods: Data from the National Ambulatory Medical Care Survey and the Outpatient Department(OPD) component of the National Hospital Ambulatory Medical Care Survey were used to estimate Chlamydia testing rates in visits by sexually-active women aged 15-25 years from 2005-2007 and, either had no visits in the preceding 12 months, or reported symptoms of Chlamydia infection (by ICD-9 code or reason for visit). Sexually-active women were identified using selected ICD-9 codes or contraception prescription. Rates were estimated by age, race, ethnicity, payment source, ambulatory care setting, metropolitan statistical area, and visit year.

Results: Among women without visits in the preceding 12 months, there were 3.9 million visits to office-based physicians or OPD's; the Chlamydia testing rate was 10.2%. The rate was higher in OPD's compared to physician offices (33.6% vs. 7.7%, p=0.0033). Among women with symptoms, there were 8.1 million visits and the testing rate was 19.5%. Again, the testing rate was higher in the OPD than in physician offices (33.5% vs. 17.6%, p=0.0042). There were no statistically significant differences in testing rates by other patient or provider factors in either subgroup.

Conclusions: While opportunities for testing were missed in a majority of the visits examined, rates appear to be lower in physician offices compared to hospital-based clinics. Increasing Chlamydia testing rates for sexually-active women presenting for ambulatory care could improve the quality of care and women's health.