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Gaps in Chlamydia Treatment Within California Family Planning Clinics

Are Patients Filling Prescriptions?

Kovaleski, Laura, MPH*; Feldman, Claire, MPH; Baker, Scott, MPH*; Howard, Holly, MPH*; Barandas, Aileen, MSN, NP; Chow, Joan, DrPH, MPH*; Bauer, Heidi, MD, MPH, MS*

Sexually Transmitted Diseases: June 2019 - Volume 46 - Issue 6 - p 370–374
doi: 10.1097/OLQ.0000000000000991
Original Studies

Background Compared with receiving medication dispensed in a health center, patients receiving prescriptions must take additional steps for treatment. Few clinics have protocols for ensuring prescriptions are filled. This study evaluated prescription fill rates for chlamydia treatment based on claims data in California Title X clinics and examined fill rates by patient demographics and clinic type.

Methods We collected treatment information during Title X site audits for a convenience sample of patients with a positive chlamydia test between January 2008 and March 2013. We categorized patients as receiving treatment on-site versus via prescription and matched prescriptions to pharmacy billing claims within 90 days of test date. We examined treatment rates by patient age, gender, and race/ethnicity, and by clinic type, and assessed the median time to treatment.

Results Among 790 patients diagnosed with chlamydia across 79 clinics, 65% (n = 513) were treated on-site and 33% (n = 260) via prescription; 17 (2%) did not have treatment information. Sixty-seven percent of prescriptions had confirmed receipt of treatment. Prescription fill rates were lower for patients age 18 years and younger (47% vs. 71%, P < 0.01) and for patients attending federally qualified health centers compared with stand-alone family planning clinics (63% vs. 88%, P < 0.01). Median time to treatment was similar for patients treated on-site (5 days) or via prescription (4 days).

Conclusions Delays in chlamydia treatment increase risk of complications and ongoing transmission. Providing medications on-site can improve treatment rates, especially among younger patients. These insights can inform clinic treatment protocols and efforts to improve quality of chlamydia care.

In California Title X clinics, one third of patients with chlamydia who received a prescription for treatment did not fill the prescription, with significant differences by age and clinic type.

From the *Sexually Transmitted Disease Control Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmon; and

Essential Access Health, Berkeley, CA

Correspondence: Laura Kovaleski, MPH, 850 Marina Bay Parkway, Richmond, CA 94605. E-mail:

Conflicts of Interest: none declared.

Sources of Funding: This work is funded by the Centers for Disease Control and Prevention.

Acknowledgments: Lani Pasion, Michelle Cantu, and Rebecca Braun for assistance with data collection and Lauren Nelson for assistance with data analysis.

Received for publication November 28, 2018, and accepted February 1, 2019.

© Copyright 2019 American Sexually Transmitted Diseases Association