An electronic medical record (EMR) alert sent to medical assistants as they prepared patients for doctor’s visits in primary care clinics substantially increased the odds that young women received chlamydia screening, according to a randomized clinical trial published this week in JAMA Network Open.

Researchers from the University of Pittsburgh School of Medicine, Magee-Womens Research Institute, and the Centers for Disease Control and Prevention (CDC) found that automated alerts increased chlamydia testing among women ages 18 to 24 years who visited primary care clinics for both reproductive health concerns and other medical issues. 

Because chlamydia is often asymptomatic, screening is recommended for sexually active women ages 24 years and younger to help prevent pelvic inflammatory disease. But screening rates in the United States remain suboptimal.

The trial included more than 18,000 office visits in primary care and obstetrics-gynecology clinics in western Pennsylvania. When eligible patients had not been screened for chlamydia within the previous year, medical assistants received reminder alerts as they were preparing patients for office visits in the examination room. The assistants could then order a test that the clinician could approve later during the visit.

A practical way to improve screening

Chlamydia tests were ordered during 13.2% of eligible visits in primary care clinics using the alert, compared with 3.8% in clinics without the automated alert, which translates to a 2.74-fold increase in the odds of a test being ordered when assistants were prompted with an automated reminder (adjusted odds ratio [AOR], 2.74; 95% confidence interval [CI], 1.94 to 3.88). 

The intervention similarly boosted screening during visits for both reproductive health concerns (AOR, 2.80; 95% CI, 1.70 to 4.62) and other medical issues (AOR, 2.94; 95% CI, 1.78 to 4.85), suggesting it helped identify screening opportunities that might have been missed otherwise.

“The alert can broaden opportunities for screening patients whenever they seek care.”

“As testing increased in visits for both reproductive and other health concerns, the alert can broaden opportunities for screening patients whenever they seek care,” the researchers write. 

The alerts did not have a significant effect on screening rates in obstetrics and gynecology practices, where the number of women who get screened is already substantially higher. 

Previous research suggests that physician-level reminders have proved only moderately effective in boosting screening rates, write the researchers, so directing automated reminders to medical assistants, rather than clinicians, may offer a practical way to improve screening.