TAMPA, Florida — Boosting screening for sexually transmitted infections (STIs) in primary care settings could help alleviate some of the barriers to optimal testing and treatment, a new quality improvement initiative suggests.
Many primary care doctors are challenged for time and send people to other healthcare settings, such as a local health department or a clinic that specializes in STI diagnosis and treatment, said Wendy Kays, DNP, APRN, AGNP-BC, AAHIVS, a nurse practitioner and researcher at Care Resource in Miami, Florida.
However, for multiple reasons, many patients do not follow up and are not screened or treated, Kays said at the Association of Nurses in AIDS Care (ANAC) 2022 Annual Meeting. Some people can afford the copay to see a primary care provider, for example, but do not have the resources to pay for a second clinical visit or laboratory testing.
In other instances, transportation can be a problem. "People, especially in the neighborhood where we are located, depend a lot on buses to go to their primary care," Kays told Medscape Medical News. But "follow-up is very important. It can promote early treatment and prevent the spread of disease."
Primary care is critical as a gateway into healthcare that could help address low rates of STI screening, she said. There is also evidence that STIs are on the rise because of the COVID-19 pandemic.
If more primary care doctors tested and treated STIs using standardized CDC guidelines, patients would not have to make a trip to another location, Kays said.
"The primary health setting...is actually the perfect place to get your screening," said Jimmie Leckliter, MSN-Ed, RN, PHN, in an interview with Medscape. He was not affiliated with the presentation. "I'm a former ER nurse, and a lot of people are using the ER as primary care, and it's not really set up to do that screening."
Leckliter suggested that primary care doctors incorporate some questions about sexual health during a regular head-to-toe checkup and ask questions in a very clinical, nonjudgmental way.
He also acknowledged that for some physicians, it can be uncomfortable to raise the issues. "Unfortunately, I think in our society, talking to people about sex is taboo, and people become uncomfortable. We need to be able to learn to put our biases aside and treat our patients. That's what our job is, added Leckliter, an adjunct faculty member at the College of the Desert's School of Nursing and Allied Health Programs in Palm Springs, California.
Clinicians should be aware of the stigma associated with sending a person to an STD clinic for further workup, Leckliter advised. "You have to look at the stigma in the community in which you're located. It makes a big difference," Leckliter said. "Is it mainly a Latino or African American community?"
Compliance Was a Challenge
Kays and colleague performed a quality improvement project focused on implementing the CDC's STI treatment guidelines at Care Resource. One goal was to educate a multidisciplinary team on the importance of screening in the primary care setting. The clientele at Care Resource consists primarily of underprivileged minorities, including the Latino, Black, gay, and transgender communities.
Six healthcare providers participated ― two medical doctors and four advanced-practice providers. They evaluated patient charts from the electronic health record system 4 weeks before the intervention and 4 weeks after.
The education had a positive impact, the researchers reported, even though three providers were compliant with the CDC recommended screening protocol and three others were not.
The quality improvement initiative had some limitations, Kays noted. "The hope is that the QI [quality improvement] process will continue moving forward, and early diagnosis and treatment of STIs will be standardized in this primary care practice."
An evidence-based tool to screen for STIs in primary care is "crucial," she added. Using a standardized, evidence-based protocol in primary care "can create positive change in patients' outcomes."
Association of Nurses in AIDS Care (ANAC) 2022 Annual Meeting: Poster SP1. Presented November 17, 2022.
The study was independently supported. Kays and Leckliter report no relevant financial relationships.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.
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Cite this: More Work Needed to Optimize STI Screening in Primary Care Settings - Medscape - Nov 21, 2022.