although the survey specifically requested that all questions be answered for STDs other than HIV, some respondents may not have consistently adhered to this request. Thus, there is a possibility of asymmetric data collection. Nevertheless, this survey does provide a modicum of insight into the STD-related activities of some MCOs serving high-risk populations.

Most MCOs reported providing a basic level of services. However, because a significant proportion of the survey respondents served populations at high risk for STDs, it is likely that typical MCOs in the United States would have substantially lower levels of involvement in STD prevention activities than those reported in this survey. In general, surveyed MCOs screened for prior STD diagnosis and sexual activity; made STD-related care accessible through primary care providers; used treatment guidelines; and guaranteed availability of acute care within 48 hours. However, few MCOs provided services beyond the expected scope of clinical practice. For example, only 22 percent of MCOs reported providing services to the general community or to sexual partners who were not plan enrollees. No MCO had a specific or dedicated STD prevention program.

Only a third of MCOs had STD-related topics in a formal training program. Further interviews with MCOs suggested that three main factors prompted the planning of STD-specific continuing medical education programs and departmental meetings: desire to improve the quality of care; physician requests for further education; and recognition of organizational weaknesses by MCO-affiliated/employed health care providers. A few MCOs have relied upon printed materials for educational outreach. For example, FHP in San Diego, CA, developed preventive health guidelines for adolescents that are distributed to all primary care providers; Human Health Care Chicago has developed a teen care manual; and Kaiser Permanente provided, in its quarterly newsletter, information for its physicians on confidentiality and consent/disclosure requirements for minors.

When MCOs with special activities in STD prevention were interviewed, they frequently discussed and highlighted various programs or activities for adolescents. For example, The Community Health Plan of Los Angeles has created a teen clinic that focuses on preventive care, particularly the psychosocial component of health issues, such as family planning, HIV testing, depression, and sexual activity. Several other organizations sponsored teen clinics that were in various stages of development and received varying levels of support.

Particularly interesting STD-related programs or activities are briefly described in the following pages. The effectiveness of many of these programs has not been formally evaluated. However, these programs and activities may serve as models for other MCOs that wish to develop activities in STD prevention.



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