Why is chlamydia screening important?

Chlamydia is the most common sexually transmitted infectious disease (STI/STD) in Minnesota and nationally, and many people who have it don’t have symptoms. Chlamydia is more common among African American, American Indian and Hispanic women and young women between the ages of 20 and 24. Since there are often no symptoms, people may not know they have it. If someone has chlamydia and isn’t treated, they can have serious health issues including infertility. Fortunately, Chlamydia is easily treated if found. Women under age 25 who are sexually active should get screened every year.

What did we do to increase chlamydia screening among our members?

Conversations about sexual activity and STIs can be difficult and embarrassing, even with your health care provider. We encourage members to be screened when they see their provider, but some providers are reluctant to have these conversations. We wanted to give members an option to get the recommended screening in a more private way.

Many clinics use a self-swab to collect STI screening samples in the clinic. We worked with our care group to show that women could successfully complete the self-swab collection at home and return it to the lab and get the same results they got in the clinic. With this validation, we worked with our on-line care provider, virtuwell, and our lab system to add this to the roster of care Virtuwell provides.

• The lab developed processes and standards for mailing the self-swab kits to members and the return of the kits through US mail.
• Virtuwell created care protocols for the on-line process to see if the service was appropriate for the member or if symptomatic testing was required. They developed workflows, documentation requirements step-by-step instructions for women using the service and other important information to ensure that the patient understood the process and could complete the screening appropriately.
• Virtuwell created discreet, custom packaging for the kit that would be mailed.
• HealthPartners and Virtuwell created outreach to inform members and the public about the service.

The service launched through Virtuwell in April 2021.

How did we reach out to members?

This service is available to all women who are over 18. HealthPartners introduced this to our members with e-mail messages if we had their email address or through messages to their on-line portal. If women didn’t have either of those, we send them a discreet mailed postcard with information about the new service.

HealthPartners also did a social media campaign to let women know this service is now available through Virtuwell.

Virtuwell also sent out emails to women who had used their service for other virtual care in the past.

How do we collaborate with providers?

HealthPartners has a partnership with our network providers called Partners in Excellence where we recognize and reward clinics that have high scores for certain areas of care. Chlamydia screening is one of those areas that clinics are encouraged to focus on.

We shared information with our network providers at Quality Connections, a meeting where Quality Improvement leaders from our contracted clinics share information about how they work to improve patient care.

We also shared the information with the MN Chlamydia Partnership, a collaboration of agencies and individuals who work to improve screening of STIs and other health issues of young adults.

What challenges did we face?

The STI self-swabs use some of the same supplies as Covid-19 tests. During the Covid-19 pandemic, priority was given to ensuring that people could get tested for Covid. A shortage of these supplies was created by the high demand for Covid testing. The service was originally scheduled to launch in 2020 but was delayed due to these supply issues.

Setting up a new service like this for an online clinic was complex and required a lot of work to identify all the regulatory issues and process planning to make it successful.

Chlamydia screening is a sensitive subject and many people are not aware of how important it is to get screened for STIs regularly. People may be reluctant to try a new service like this if they are not sure how it will work.

Results

We measured success in two ways. How many people got the service through Virtuwell after they had heard about it, and the overall chlamydia screening rate.

Table 1 shows how many people who got a message about the service actually used it. For members who got the email from Virtuwell, 2.59% of them got the screening. For members who got the notification from HealthPartners, 9.34% received the service. While these rates are lower than some of our other outreach campaigns, it shows that some people do want to access this kind of confidential service through an on-line clinic.

Overall, or chlamydia screening rate increased in 2021 compared to 2022 but did not rebound fully to pre-pandemic levels. Screening rates for Medicaid members are higher than rates for commercial members.

Ongoing work

HealthPartners will continue to work to educate members of this important screening. We will continue to offer STI screening through the Virtuwell platform and to encourage our providers to prioritize screening for women at risk.