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Fairview primary care clinics have adopted a sort of “opt out” strategy, presuming that young patients will be tested even if they aren’t sexually active or are in monogamous relationships. Instead of saying “ ‘I know you’ve been with Bill for 10 years. You should be low risk for chlamydia. Do you really want that test?” doctors are telling such patients that “ ‘The medical literature still says I should test you,’ ” Overton said.
Pop-up reminders in electronic medical records also emphasize that screening is medically recommended, and Fairview doctors are given performance bonuses for improving their screening rates.
HealthPartners similarly rewards doctors in its health insurance plan networks who screen at least 75 percent of their at-risk female patients. None reached that target last year, though, so the insurer instead rewarded the clinic that came closest.
Data on clinic screening in Minnesota, compiled by a nonprofit known as Minnesota Community Measurement, does not include charitable clinics such as Nucleus or the Annex Teen Clinic in Robbinsdale, which can provide greater privacy by charging teens sliding fees and not billing their parents’ insurance.
Another step in reducing chlamydia is follow-up testing for infected patients after treatment, because of the chance that they could be reinfected if their sexual partners aren’t treated. Teens won’t return unless clinics nag them to, Fink said. “If you remember when you were 22 years old and somebody told you to do something in three months, you probably said, ‘Yeah, whatever.’ ”
Such strategies might cut chlamydia infections in future years, Fink said, but major progress will require more honest discussions between sexually active teens and their parents about STD testing.
“You use your teeth and you get your teeth cleaned,” she said. “Think of it like that. It’s just something you do. It doesn’t mean you’re bad if you have to get some plaque cleaned off.”
Jeremy Olson • 612-673-7744
Rebecca Harrington, a University of Minnesota student reporter on assignment for the Star Tribune, contributed to this report.