Outreach Partner Notification 5 years on Linda Lewis Senior Health Adviser Carlton Street Clinic 27 – 29 Carlton Street Blyth Northumberland
Dec 18, 2015
Outreach Partner Notification 5 years on
Linda Lewis
Senior Health Adviser
Carlton Street Clinic27 – 29 Carlton StreetBlythNorthumberlandNE24 2DT
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
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
2007 reason for test
17
12
13
8
male
symptoms
C4a Contacts
STI screen
no clinical data
4 not actioned
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
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