A Quality Improvement Project to Increase Screening for Chlamydia in a Primary Care Setting

Background: Chlamydia is the most common bacterial sexually transmitted infection in the United States. Nearly two-thirds of reported chlamydia cases occur in individuals aged 15-24 years. Most women infected with chlamydia are asymptomatic. Centers for Disease Control and Prevention recommends annual screening for chlamydia in all sexually active women 24 years and younger. Untreated chlamydia infections can cause pelvic inflammatory disease, chronic pelvic pain, infertility, and potentially fatal ectopic pregnancy. Methods: The purpose of this quality improvement project was to increase chlamydia screening rates in a primary care clinic in Farmington, Utah. An educational presentation and clinical practice guideline (CPG) were developed and presented to stakeholder medical assistants (MAs). A self-assessment survey was used to gather baseline knowledge, attitude, and comfort with chlamydia screening from the MAs before and after implementation. The CPG was used over 12 weeks at the clinic. Pre- and post- intervention electronic health record audits were conducted to determine chlamydia screening offered to patients and then completed. Results: Before implementation of the CPG, only 30% (n=30) of eligible patients were offered chlamydia screenings, and 25% (n=25) completed screenings. Following implementation, 54.1% (n=46) of eligible patients were offered chlamydia screenings, and 28% (n=24) completed screenings. MAs who completed both the pre- and post-survey (n=10) indicated greater knowledge of chlamydia and its reproductive harm and increased comfort in offering to screen to patients. There was no significant increase in completed chlamydia screenings. Conclusion: The CPG effectively increased the number of patients who were offered chlamydia screening in a primary care practice but did not significantly increase patient uptake of screenings. Further research will need to be conducted to determine factors that may increase patients' willingness to be screened for chlamydia and factors that may preclude all eligible women from being offered screening.