outreach partner notification 5 years on linda lewis senior health adviser carlton street clinic 27...
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Outreach Partner Notification 5 years on
Linda Lewis
Senior Health Adviser
Carlton Street Clinic27 – 29 Carlton StreetBlythNorthumberlandNE24 2DT
About Northumberland– Over 2,000 square miles– Largest county in England– Diverse population
History
•2003-2004•December 2003 Commenced at Northumberland
– Setting up GUM service • working with lead nurse to develop GUM Service
– GP Questionnaire re Sexual Health Strategy• Identified over 8o% GP Practices were prepared to undertake sexual health
screening but only 10% would undertake partner management.
– Discussion with local laboratory re feasibility of sending copy reports to HA
The beginning
2004
Commencement of Outreach Chlamydia Partner Notification Pathway– Overall aim:-
• to offer all patients within Northumberland who test positive for Chlamydia the same follow-up care and management as those who attend a GUM service, and therefore reduce the number of untreated infections in the sexually active population.
• Initially this was outreach only with HA contact via telephone / letter. Referring those who needed further screening etc to nearest GUM.
• From April 2004 offering HA service for all GUM clinical sessions both at base and outreach clinics
history• 2004
– Collaboration with Clinical Governance in developing• Leaflets• Care pathway
– Working with Secondary Care provider• identification of link person• training
– Road shows in the 4 geographical areas• Raising awareness of GUM service• Raising awareness of STI’s • Introducing Chlamydia Care Pathway
– Mail shot to all primary and secondary service providers
2004
• Lab reports received in accordance to previous provider service
• April Formal pathway commenced– All hospital reports acted upon– Majority of remaining reports not acted upon
• Unable to get permission from referrer
over 45% of reports were not acted upon
process
• Positive Chlamydia lab result– Set recall date
• 1 month• 2 weeks if pregnant
• If no referral contact referrer– Letter (review 1 month)– Telephone (review 2 days)– E-mail (review 2 days)
Depending on outcome
• Contact patient by chosen method– Telephone– letter
• Discussion to include– Treatment– Compliance– Partners (identifying sexual activity to ensure appropriate rx)– Safer sex– Offer further sti screen
2004 and 2005 lab reports
2004 and 2005 testing sites (male)
2004 and 2005 testing sites (female)
2004 reason for testfemale
25% re-infection
2005 reason for test
35%
28%
7%
30%
0
male
symptoms
C4a contacts
STI screen
no clinical
20% possibility of re-infection (10 patients not aware of diagnosis)
2004
Partner Notification Management difficult
Lone HA
Time constraints
Problems contacting referrerOver 10% of patients did not know their diagnosis and of the remaining a further 15% were at risk of re-infection
2007and 2008 lab reports
2007 testing sites
18653
40
11
female
GPWGH gynaeWGH anteOther hosp 24
23
3
male
GPHMPYIOther hosp
2007 reason for test
17
12
13
8
male
symptoms
C4a Contacts
STI screen
no clinical data
4 not actioned
2008 testing sites
190
35
50
female
GPWGH anteWGH gynaOther Hosp
41
10
4
Male
GPHMPYIOther hosp
2008 reason for test
164
26
40
36
18
female
symptomsC4a con-tactsProcedureSTI screenNo clinical Data
21
21
6
7
male
symptomsContact C4aNo clinical DataSTI screen
2007 Index Patient ManagementMale
– GP• 29 were initially treated by GP • 3 were referred directly to GUM and treated• 3 DNR to HA letter• 1 attended GUM for retreatment
– HMPY• 3 were treated by HMPYI (no PN activated)
• However 13 GP’s DNR (unable to action further) and 2 moved out of area
2007 Index Patient Management
• Female– 78 were not treated by initiating test site
• 24 WGH gynae• 31 WGH antenatal• 23 GP
• Treatment given– 32 GP (hospital index patients)– 37 GUM
• 4 index patients DNR and remainder moved
2007 Female PN outcome
• 3 retreated by GUM• 2 retreated by initiating test GP• 1 aware of diagnosis but not treated at time
of contact• 9 not aware of diagnosis
2008 IP female management
• 9 were not aware of diagnosis• 9 were aware but not treated• 12 needed retreatment by GUM• 17 needed retreatment form GP
2008 IP male management
• 2 were not aware of diagnosis• 1 needed retreatment by GUM
Female Partner management• 154 IP gave partner details
– 2 x 3 – 11 x2– 140 x 1 giving total of 168
• 54 attended GUM• 93 attended GP
– 4 were informed by HA– 3 informed by IP– 2 needed retreatment
Male partner management
• 21 patients identified 25 partners– 4 attended GUM– 18 attended GP
– 4 follow up undertaken by other gum– 6 follow up undertaken by HMPYI
Thoughts
Increasing number of GP screening and treating C4a
what about other infections?
more proactive screening prior to coil and other procedures
Should we as Health Advisers be looking outside the “box” of GUM?