Hepatitis: Hoover K

Hoover K, Bohm M, Keppel K. · Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Sex Transm Dis. · Pubmed #18836391 No free full text.

Abstract: The Centers for Disease Control and Prevention (CDC) defines a health disparity as a "[health] difference that occurs by gender, race or ethnicity, education or income, disability, geographic location, or sexual orientation." Health equity is achieved by eliminating health disparities or inequalities. Measuring health disparities is a critical first step toward reducing differences in health outcomes. To determine the methods to be used in measuring a health disparity, several decisions must be made, which include: (1) selecting a reference group for the comparison of 2 or more groups; (2) determining whether a disparity should be measured in absolute or in relative terms; (3) opting to measure health outcomes or health indicators expressed as adverse or favorable events; (4) selecting a method to monitor a disparity over time; and (5) choosing to measure a disparity as a pair-wise comparison between 2 groups or in terms of a summary measure of disparity among all groups for a particular characteristic. Different choices may lead to different conclusions about the size and direction of health disparities at a point in time and changes in disparities over time.The objective of this article is to review the methods for measuring health disparities, provide examples of their use, and make specific recommendations for measuring disparities in the incidence of sexually transmitted diseases (STDs).

Hoover K, Tao G, Kent C. · Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Obstet Gynecol. · Pubmed #18827133 No free full text.

Abstract: OBJECTIVE: To estimate demographic characteristics of nonpregnant women who seek health care in hospital outpatient clinics, and the proportion of visits where a chlamydia test was not done in asymptomatic young women at preventive visits and in symptomatic women. METHODS: We analyzed data from the 2005 National Hospital Ambulatory Medical Care Survey to estimate the number of visits made by nonpregnant women aged 15-25 years and 26-35 years. We estimated the proportion of preventive visits where young women were not screened for chlamydia and the proportion of visits where women with signs or symptoms of chlamydia were not tested. RESULTS: In 2005, 5.2 million visits were made by nonpregnant women aged 15-25 years to outpatient clinics: 21.3% were by black non-Hispanic women, 15.2% by Hispanic women, 41.9% by women with Medicaid/State Children's Health Insurance Program insurance, and 10.8% by women with signs or symptoms of chlamydia. These young women were not screened at 84.0% of 1.2 million asymptomatic preventive visits, and were not tested for chlamydia at 78.3% of 0.6 million visits where they presented with signs or symptoms of chlamydia. Women aged 26-35 years were not tested at 86.3% of 0.4 million visits where they presented with signs or symptoms of chlamydia. CONCLUSION: While low chlamydia screening coverage has been reported, the low level of diagnostic testing in outpatient clinics was unexpected. Simple and effective interventions are needed to increase both diagnostic testing and screening of young women for Chlamydia in outpatient clinics, a venue that provides care to at-risk populations.

Hoover K, Tao G. · Division of Sexually Transmitted Disease Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. · Obstet Gynecol. · Pubmed #18448741 No free full text.

Abstract: OBJECTIVE: To identify missed opportunities for chlamydia screening in ambulatory care offices. METHODS: We analyzed data from the 2005 National Ambulatory Medical Care Survey to estimate the number of visits to obstetrician-gynecologists and primary care physicians (family and general practitioners, internists, and pediatricians) for preventive care, pelvic examinations, Pap tests, and urinalyses for nonpregnant women aged 15-25 years, and the proportion of these visits at which chlamydia tests were not performed. RESULTS: Obstetrician-gynecologists provided care for nonpregnant women aged 15-25 years at 6.3 million office visits during 2005, and primary care physicians at 20.9 million visits. Although obstetrician-gynecologists conducted only 23.1% of visits made by young women, they conducted 68.8% of visits with pelvic examinations and 71.1% of visits with Pap tests. Primary care physicians conducted 77.5% of visits with urinalyses. Obstetrician-gynecologists did not perform a chlamydia test at 3.2 of 3.8 million (82.1%) visits with pelvic examinations and at 1.8 of 2.3 million (77.3%) visits with Pap tests. Primary care physicians did not perform a chlamydia test at 2.9 of 3.0 million (99.1%) visits with urinalyses. CONCLUSION: There are many missed opportunities for chlamydia testing of young women in ambulatory care visits - during pelvic examinations, Pap tests, and urinalyses. Effective and simple interventions are needed to increase targeted chlamydia screening of women by physicians. LEVEL OF EVIDENCE: III.