Trends in Clinic Visits and Diagnosed C. trachomatis and N. gonorrhoeae Infections Following the Introduction of a Co-Pay in an STD Clinic C. Rietmeijer L. Lloyd G. Alfonsi Denver Public Health Department Denver, Colorado Presented at the 2004 National STD Prevention Conference March 8, 2004 Philadelphia, PA
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Trends in Clinic Visits and Diagnosed C. trachomatis and N. gonorrhoeae Infections Following the Introduction of a Co-Pay in an STD Clinic C. Rietmeijer.
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Trends in Clinic Visits and Diagnosed C. trachomatis and N. gonorrhoeae Infections
Following the Introduction of a Co-Pay in an STD Clinic
C. RietmeijerL. Lloyd
G. Alfonsi
Denver Public Health DepartmentDenver, Colorado
Presented at the 2004 National STD Prevention ConferenceMarch 8, 2004
Philadelphia, PA
Background
• Offering of clinical (diagnostic and treatment) services has historically been a key strategy for STD control and prevention
• To maximize the impact of this strategy, STD clinical services have traditionally been offered at no or low cost to the patient
Background - 2
• To offset decreases in public funding, fee for services, usually in the form of co-payments, may be initiated or increased
• However, little is known about the effects of such (co-)payments on access to and utilization of services and the ability of STD control programs to diagnose and treat STDs
Background - 3
• The Denver Metro Health Clinic (DMHC) is the largest STD clinic in the Rocky Mountain region
• Due to budget shortfalls, DMHC was forced to introduce co-payments to its clients in December, 2002
DMHC Co-Payment Structure
• $15– Residents of Denver, Adams, Arapahoe, or Douglas
County presenting with a new problem
• $65– Residents of other counties presenting with a new
problem
• None– Patients with a known positive test for STDs with
documentation of positive results– Contacts of patients with known STDs with
documentation of contacts status– Follow-up visits– HIV testing only ($10.00 optional)
DMHC Co-Pay Statistics2003
0
1000
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7000
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9000
No Pay
$15
$10
$65
LWBS
Objective
• To evaluate trends in patient visits and diagnosed CT and GC infections prior to and after the introduction of the co-pay at DMHC
Methods - 1
• Retrospective analysis of the computerized DMHC medical record database
• Comparing first three quarters of 2002 (prior to initiation of co-pay) to first three quarters of 2003 (after initiation of co-pay)
Methods - 2
• Analysis of data on GC and CT cases reported for the City and County of Denver to the Colorado Department of Public Health and Environment
• Comparison of DMHC-reported GC and CT cases in Denver with cases reported by other providers for the first 3 quarters of 2002 and 2003
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JAN MAR MAY JUL SEP NOV JAN MAR MAY JUL SEP
# VISITS
2002 2003
Start Co-Pay
Denver Metro Health Clinic Visits2002 -2003
Clinic Visits DMHC 2002– 2003 by Quarter
0
500
1000
1500
2000
2500
3000
3500
4000
1st Qtr 2nd Qtr 3rd Qtr
2002
2003
Total visits 2002 through third quarter: 11,382Total visits 2003 through third quarter: 8,132Difference through third quarter: 3,250 = 28.5%