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and four MCOs (15 percent) followed internally produced guidelines. Twenty MCOs (74 percent) guaranteed acute care for all conditions within 48 hours; however, these policies did not usually specify STDs or any other specific clinical condition. Within the MCO staff, primary care providers most frequently provided STD-related care (100 percent), followed by obstetricians/gynecologists (96 percent). Other providers of STD-related care included specialists (48 percent), publicly sponsored STD clinics (41 percent), and non-MCO health facilities (19 percent). Four health plans (15 percent) required patients to obtain referrals to other physicians or providers to obtain STD-related care.
Most MCOs (92 percent) permitted adolescents to obtain STD-related care without obtaining parental permission, and none notified parents of this care. Thirteen plans (52 percent) adhered to a specific policy that guaranteed adolescent and adult confidentiality, but most of these were general nondisclosure policies that did not specifically refer to STDs or STD-related care. However, preventive medicine guidelines were more specific: 21 MCOs (78 percent) required or encouraged health care providers to discuss sexual activity during routine adolescent health care visits; 12 (46 percent) had an STD-related activity specifically targeted towards adolescents; and 10 (39 percent) automatically offered chlamydial screening to all women of childbearing age (15-44 years). None of these health plans had a specific or categorical STD prevention program at the time the survey was conducted.
Five MCOs (19 percent) provided STD-related services to nonenrolled populations in their communities by participating in case-finding, screening for STDs or related conditions, and partner identification/notification. Three organizations (11 percent) routinely referred patients with STDs to public facilities for treatment and/or preventive services; and seven (26 percent) referred their patients for such public health activities as contact-tracing and partner notification. Contractual agreements that specified STD-related care were rare: one MCO had a contract with a purchasing group that specified STD-related services to be provided, and six MCOs (22 percent) had contracts or agreements with government agencies that specifically addressed STD-related services. However, these contracts and agreements almost always referred specifically to HIV-related services.
Five MCOs (19 percent) conducted STD-related clinical or epidemiological research. Most frequently, this research addressed HIV-related issues. Nine MCOs (33 percent) reported a formal training program in STD-related topics for health care staff, usually in the form of continuing medical education; and 13 (48 percent) had plans for future STD-related programs or activities.
There are several limitations to these survey data. Because of the small sample size and sample selection, these data should be considered preliminary and may not be representative of MCOs serving high-risk populations. In addition,