Let's Talk: Improving Physician-to-Patient Communication about Sexually Transmitted Diseases

Between 1998 and 2000, researchers at the University of California, Los Angeles (UCLA), Center for Health Policy Research surveyed Medicaid managed care organizations on their preventive practices for sexually transmitted diseases (STDs).

The primary objective of the survey was to describe how managed care organizations address prevention and control of STDs among high-risk populations. In all, 114 medical directors and primary care physicians in 7 metropolitan areas with high rates of STDs were interviewed by telephone.

Key Findings

  • Findings indicated that most Medicaid managed care organizations do not actively promote physician practices that are consistent with recognized STD practice guidelines.

  • In contrast, most medical group and physician practice appears to be ahead of managed care recommendations. For example:

    • Just 53 percent of Medicaid managed care organizations recommend that physicians take routine sexual histories on new patients.
    • Only 35 percent have developed or adapted practice guidelines covering STD management.
    • Only 33 percent recommend that physicians encourage infected patients to urge their sex partners to get tested for STDs.
    • Just 52 percent recommend that physicians alert local public health departments of STD cases.

      In all of these cases, the percentage of practices engaging in these activities was higher.

Key Recommendations

  • Among the investigators' recommendations for Medicaid managed care organizations was to adopt practice guidelines to standardize STD care, and to reimburse for the testing and treatment of partners of infected patients, even if the partners are not enrolled in the managed care organization.

  • The investigators urged state health departments to consider legally mandating certain practices, such as ensuring the confidentiality of patients who are minors and reporting STD cases to health departments.

The investigators completed a report on their findings—entitled Delivery of Sexually Transmitted Disease Services in Medicaid Managed Care—and distributed more than 280 copies of it to the CDC, medical and health care researchers, Medicaid managed care organization medical directors, and state Medicaid directors.