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Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act.

ABSTRACT: Following the 2014 expansions of Medicaid and private health insurance through the Affordable Care Act, municipal sexually transmitted disease (STD) clinics-which have historically served predominantly uninsured patients-have been threatened with budget cuts nationwide. This study was conducted to evaluate the impact of the insurance expansions on the demand for STD clinic services.The proportion of total incident sexually transmitted infections in Baltimore City that were diagnosed at STD clinics was compared between 2013 and 2014, and a multivariate analysis was conducted to determine factors associated with diagnosis at an STD clinic. Analyses were conducted in July 2015.There was no change in the overall proportion of sexually transmitted infection diagnoses made at STD clinics from 2013 to 2014 (relative rate, 1.03; 95% CI=0.95, 1.11). Hispanic ethnicity, black race, male sex, and age >24 years were associated with an increased likelihood of STD clinic utilization (p<0.0001).Despite the Affordable Care Act's insurance expansion measures, the demand for STD clinics remained stable. These safety net clinics serve patients likely to face barriers to accessing traditional health care and their preservation should remain a priority.

SUBMITTER: Mehtani NJ

PROVIDER: S-EPMC4992609 | biostudies-literature | 2016 Sep

REPOSITORIES: biostudies-literature

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Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act.

Mehtani Nicky J NJ Schumacher Christina M CM Johnsen Luke E LE Khaldun Joneigh S JS Chaulk C Patrick CP Ghanem Khalil G KG Jennings Jacky M JM Page Kathleen R KR

American journal of preventive medicine 20160527 3

<h4>Introduction</h4>Following the 2014 expansions of Medicaid and private health insurance through the Affordable Care Act, municipal sexually transmitted disease (STD) clinics-which have historically served predominantly uninsured patients-have been threatened with budget cuts nationwide. This study was conducted to evaluate the impact of the insurance expansions on the demand for STD clinic services.<h4>Methods</h4>The proportion of total incident sexually transmitted infections in Baltimore ...[more]

PMID: 27242080

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Project description:The Affordable Care Act (ACA) eliminated cost-sharing for evidence-based preventive services in an effort to encourage use.To evaluate use of colorectal cancer (CRC) screening in a national population-based sample before and after implementation of the ACA.Repeated cross-sectional analysis of the Medical Expenditure Panel Survey (MEPS) between 2009 and 2012 comparing CRC screening rates before and after implementation of the ACA.Adults 50-64 with private health insurance and adults 65-75 with Medicare.Self-reported receipt of screening colonoscopy, sigmoidoscopy, or fecal occult blood test (FOBT) within the past year among those eligible for screening.Our study included 8617 adults aged 50-64 and 3761 adults aged 65-75. MEPS response rates ranged from 58 to 63%. Among adults aged 50-64, 18.9-20.9% received a colonoscopy in the survey year, 0.59-2.1% received a sigmoidoscopy, and 7.9-10.4% received an FOBT. For adults aged 65-75, 23.6-27.7% received a colonoscopy, 1.3-3.2% a sigmoidoscopy, and 13.5-16.4% an FOBT. In adjusted analyses, among participants aged 50-64, there was no increase in yearly rates of colonoscopy (-0.28 percentage points, 95% CI -2.3 to 1.7, p?=?0.78), sigmoidoscopy (-1.1%, 95% CI -1.7 to -0.46, p?=?<0.001), or FOBT (-1.6%, 95% CI -3.2 to -0.03, p?=?0.046) post-ACA. For those aged 65-75, rates of colonoscopy (+2.3%, 95% CI -1.4 to 6.0, p?=?0.22), sigmoidoscopy (+0.34%, 95% CI 0.88 to 1.6, p?=?0.58) and FOBT (-0.65, 95% CI -4.1 to 2.8, p?=?0.72) did not increase. Among those aged 65-75 with Medicare and no additional insurance, the use of colonoscopy rose by 12.0% (95% CI 3.3 to 20.8, p?=?0.007). Among participants with Medicare living in poverty, colonoscopy use also increased (+5.7%, 95% CI 0.18 to 11.3, p?=?0.043).Eliminating cost-sharing for CRC screening has not resulted in changes in the use of CRC screening services for many Americans, although use may have increased in the post-ACA period among some Medicare beneficiaries.

Project description:Many individuals remain sexually active into their eighth decade. Surveillance data suggest that rates of sexually transmitted infections in older patients are increasing. We compared demographics, risk behaviors, and predictors of acute infections in patients 50 years and older versus younger patients attending sexually transmitted disease clinics in Baltimore, Maryland. This was a retrospective study from a large electronic database of visits to two urban sexually transmitted disease clinics between 2005 and 2010. Proportions were compared using the Chi square test. Logistic regression was used to assess predictors of acute sexually transmitted infections in older versus younger groups. It was found that patients over 50 were more likely than younger patients to report never using condoms (32.6% [CI 0.31-0.34] versus 24.1% [CI 0.23-0.25]). The overall prevalence of acute sexually transmitted infections was 18.1% (CI 0.17-0.19) in older and 25.8% (CI 0.25-0.27) in younger patients. Older women were more likely to be diagnosed with trichomoniasis (21.5% [CI 18.6-24.5] versus 13.1% [CI 11.5-14.8]). Black race was predictive of having an acute sexually transmitted infections in younger men (OR 2.2 [CI 1.47-3.35]) and women (OR 2.7 [CI 1.34-5.30]) but not in older men (OR 1.2 [CI 0.79-1.73]) or women (OR 1.2 [CI 0.43-3.15]). Older age was associated with a decreased risk of acute STI diagnosis in younger men and older women only, while having had sex for money or drugs in the past month was predictive only in younger women. Reporting symptoms and increasing numbers of sexual partners in the last six months was predictive of acute sexually transmitted infection diagnosis in all age groups. Older patients seeking care at sexually transmitted disease clinics engage in important risk behaviors. Race, a factor predictive of acute sexually transmitted infections in younger patients is not a significant predictor of sexually transmitted infections in older persons.

Dataset Information

Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act.

Publications

Continued Importance of Sexually Transmitted Disease Clinics in the Era of the Affordable Care Act.

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