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Patients Attending STD Clinics in an Evolving Health Care Environment: Demographics, Insurance Coverage, Preferences for STD Services, and STD Morbidity

CELUM, CONNIE L. MD, MPH*†; BOLAN, GAIL MD; KRONE, MELISSA MS*; CODE, KAREN MHA*; LEONE, PETER MD§∥; SPAULDING, CORA MD§; HENRY, KEITH MD; CLARKE, PEGGY MPH#; SMITH, MARK MD, MBA**††; HOOK, EDWARD W. III MD‡‡

Original Article

Objectives: To characterize client demographics, sexually transmitted diseases (STD) morbidity, insurance status, reasons for attending public STD clinics, and future preferences for source of STD services.

Design: Cross-sectional study of 2,490 clients attending five urban STD clinics for new problems with interviewer-administered 23-item questionnaire and chart review to obtain clinical and laboratory STD diagnoses.

Results: Participants were young (51% <25 years of age), minority (64% nonwhite), poor (43% ≤$10,000/year), and largely uninsured (59% uninsured, 27% private insurance, and 14% Medicaid). Half had previously visited the STD clinic, and 81% had used other providers for non-STD services in the prior 3 years. STD symptoms were cited as the reason for the visit by 63%. The most common factors associated with seeking care at these STD clinics were walk-in services, costs, and confidentiality concerns. STD morbidity was high; 66% of clients were diagnosed with one or more STD. Most (68%) clients preferred to be treated at the STD clinic in the future if they could go anywhere for STD services.

Conclusions: STD clinics see young, minority, poor, and uninsured clients with high STD rates. Even with unlimited future choice, two thirds of the clients surveyed would still prefer to be treated at STD clinics. This study indicates the continuing need for publicly funded, categorical STD clinics in urban areas with high STD morbidity and the importance of easily accessible, confidential, expert STD services from the private sector and managed care organizations.

* From the University of Washington, †Seattle-King County Department of Public Health, Seattle, Washington; ‡San Francisco Department of Public Health, San Francisco, California;§University of North Carolina, Chapel Hill, ∥Wake County Department of Public Health, Chapel Hill, ¶University of Minnesota, Minneapolis and St. Paul Department of Public Health, #American Social Health Association, Research Triangle Park, North Carolina; **Henry J. Kaiser Family Foundation, ††University of California, San Francisco; ‡‡University of Alabama at Birmingham and Jefferson County Department of Health, Birmingham, Alabama.

The authors thank Kay Flamminio of the American Social Health Association who provided invaluable assistance in coordinating the study at the five cities, the staff and interviewers at the five STD clinics for study implementation, and Tim Tyree, Charity Richey, and Jim Hughes, PhD, for their assistance in data analysis.

Supported in part by the American Social Health Association through a grant from the Henry J. Kaiser Family Foundation. Drs. Celum, Hook, and Bolan were also funded by the Centers for Disease Control and Prevention STD/HIV Prevention Training Centers (grant R30 CCR 000926–11). Questionnaire design and development was supported in part by a grant from the R.W. Johnson Pharmaceutical Research Institute (Tony Paviglianti).

Reprint requests: Connie Celum, MD, MPH, Harborview STD Clinic, Box 359777, 325 9th Avenue, Seattle, WA 98104–2499.

Received for publication April 4, 1997, revised July 11, 1997, and accepted July 31, 1997.

© Copyright 1997 American Sexually Transmitted Diseases Association