A randomized trial of strategies to increase chlamydia screening in young women

Prev Med. 2006 Oct;43(4):343-50. doi: 10.1016/j.ypmed.2006.04.019. Epub 2006 Jun 19.


Objective: Despite the recommendations of numerous clinical practice guidelines, testing of at-risk women for Chlamydia trachomatis infection remains low. We evaluated an intervention to increase guideline-recommended chlamydia screening.

Method: In a two-by-two factorial design randomized trial conducted in 2001-2002, 23 primary care clinics at Group Health Cooperative in Washington State were randomized to either control (standard) or intervention (enhanced) guideline implementation arms. Clinic-level intervention strategies included use of clinic-based opinion leaders, individual measurement and feedback, and exam room reminders. A second patient-level intervention, a chart prompt to screen for chlamydia, was delivered in a random sample of 3509 women. The outcome measure was post-intervention chlamydia testing rates among sexually active women ages 14-25.

Results: The clinic-level intervention did not significantly affect overall chlamydia testing (odds ratio (OR) = 1.08, 95% confidence interval (CI) 0.92-1.26, P = 0.31). However, testing rates increased significantly among women making preventive care visits (OR, Pap test visit = 1.23, 95% CI, 1.01-1.51, P = 0.04; OR, physical exam visit = 1.22, 95% CI 1.06-1.42, P = 0.009, intervention vs. control clinics). The chart prompt intervention had no significant effect (OR = 1.08, 95% CI 0.94-1.23, P = 0.27).

Conclusions: Interventions to improve guideline-recommended chlamydia testing increased testing among women making preventive care visits. Additional organizational change and/or patient activation strategies may improve plan-wide testing, particularly among asymptomatic women.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Chlamydia Infections / diagnosis*
  • Chlamydia Infections / prevention & control
  • Chlamydia trachomatis / isolation & purification*
  • Female
  • Group Practice, Prepaid / standards*
  • Guideline Adherence
  • Humans
  • Mass Screening / statistics & numerical data*
  • Practice Guidelines as Topic
  • Preventive Medicine / standards*
  • Primary Prevention / standards*
  • Program Evaluation
  • Washington
  • Women's Health Services / standards*