None listed
Conditions
Brief summary
Background: A significant gap exists between recommended and actual management of patients diagnosed with sexually transmitted infections (STIs) in primary care. Guidelines recommend that partner notification and testing for reinfection 3months post-treatment should be routinely undertaken for patients diagnosed with STIs. These processes are important to interrupt STI transmission, reduce reinfection and the health consequences of untreated infection, but for a range of reasons do not always occur. Study aim: This pilot intervention study will trial new strategies designed to improve partner notification outcomes including reinfection rates for patients at participating practices. Design: Primary care practices will trial one of two models of health service delivery. Model 1: Three practices will work with a specialist sexual health advisor to ensure patients receive information about, and follow-up on partner notification. Model 2: Three practices will provide patients with information about, and follow-up on partner notification once key team members have received partner notification training from the specialist sexual health advisor. Both groups will be asked to offer new partner notification information sheets for patients and their partners and will trial the use of a text message reminder to recall patients for a 3month test of reinfection. Measures: Between group comparison of the proportions of patients who report having notified at least one partner/sexual contact; and proportions of patients who report at least one partner/sexual contact has been treated. Proportions of patients in both groups returning for a 3-month test of reinfection will be compared with baseline data collected prior to the intervention. Comment: This pilot study is not powered to detect significant differences in clinical outcomes. We are testing new health service delivery processes that if acceptable to providers, and suggestive of improved patient outcomes could be integrated into routine patient care, and/or tested further in an adequately powered intervention study.
Interventions
This health service delivery intervention is offered to all patients diagnosed with Chlamydia/Gonorrhoea at the practice. Practices rather than patients are the study participants. We are trialling 2 models:
Model 1. Health advisor assisted partner notification - partner notification discussed in clinic as per usual care (varies from clinician to clinician, visit duration variable 10-20minutes). Patient is then referred to specialist sexual health advisor (HA) for phone follow-up at 1week post-
This health service delivery intervention is offered to all patients diagnosed with Chlamydia/Gonorrhoea at the practice. Practices rather than patients are the study participants. We are trialling 2 models: Model 1. Health advisor assisted partner notification - partner notification discussed in clinic as per usual care (varies from clinician to clinician, visit duration variable 10-20minutes). Patient is then referred to specialist sexual health advisor (HA) for phone follow-up at 1week post-treatment. 1-week call by HA: to check on treatment compliance and partner notification (with further advice and assistance provided as needed) - approx duration of call 10minutes. Model 2. Training for practice team members to facilitate partner notification processes in the practice. Two team members attend 2.5hr partner notification training session provided by specialist sexual health advisor, sexual health clinician and research team members. Partner notification is delivered by the practice nurse who received PN training where possible or by the clinician at the treatment consultation as per usual care (varies from clinician to clinician, visit duration 10-20minutes). Follow-up phone call 1-week post-treatment by practice nurse who received PN training to check on treatment compliance and partner notification (with further advice and assistance provided as needed) - approx duration of call 10minutes The partner notification training workshop will be run as a small-group session led by a sexual health advisor and clinical nurse specialist from the local sexual health service. Content will be drawn from local and international best practice guidelines (eg NZ Sexual Health Society, Australasian ASHM, British BASHH guidelines and US CDC and public health approaches to notifiable diseases which include gonorrhoea and chlamydia). The workshop will cover rationale for notifying partners and returning for test of reinfection, how to initiate discussion about partner notification, patient and provider-led approaches, risk reduction advice, phone follow-up to check progress and offer further assistance, with role-play used to simulate patient-provider discussion. Both models: Clinician asked to offer newly developed partner notification information sheet for patients and partners. Reminder text message sent at 2-2.5mths post treatment to recall patients for a 3mth test of reinfection.
Sponsors
Dr Sally Rose
Study design
Allocation
Non-randomised trial
Primary purpose
Educational / counselling / training
Eligibility
Sex/Gender
All
Healthy volunteers
No
Inclusion criteria
Primary care practices diagnosing at least 50 cases of chlamydia or gonorrhoea annually. Not currently undertaking partner notification for all STI cases. Practices rather than their patients are the participants in this pilot study. All patients diagnosed with chlamydia or gonorrhoea at participating practices during the study period will be included in data collection.
Exclusion criteria
Unwilling to trial new approaches to partner notification. Practices rather than their patients are the participants in this study so there are no relevant exclusion criteria for patients.
Outcome results
None listed