National STD Prevention Conference Philadelphia, PA March 8, 2004 What Do Physicians Know and Want to Learn about STD/HIV Partner Notification?

Background 2000 NYS HIV Reporting Law requires medical providers to report known contacts/partners to allow for the provision of partner notification assistance Name, locating information, domestic violence (DV) screen, and status of partner assistance included for each partner

Rationale Increased role of medical providers as gatekeeper for PN NYS STD/HIV Prevention Training Center (CDC-funded PTC) collaborated on a statewide physician survey 2003 survey replicated (and expanded) national STD CONTACT survey done by CDC in 1999

NYS CONTACT2003: Replicated study design from CDC National CONTACT Survey (Random sample of physicians - 5 specialties treating most STDs) Repeated most questions from original survey (reporting, practice patterns) to measure change from 1999 to 2003 New questions on DV screening, partner notification (PN) proficiencies & training Survey Response rate: 61% (N=835)

Description of Respondents Medical Specialty

Description of Respondents

How proficient did physicians feel they were at key partner elicitation and notification tasks? 13 proficiency dimensions were adapted from skill inventory in standardized partner services courses taught by the STD/HIV Prevention Training Centers Physicians self-rated their proficiency level using 4 pt. scale (1=limited 2=fair 3=good 4=excellent)

Lowest Rated Proficiency Dimensions Among NYS Physicians Limited(1) Fair (2)Good/Ex(3/4) Describing services available47% 30% 23% through HD PN program Asking for addl. partner46% 28% 26% locating/identifying info Establishing specific plan45% 31% 24% with timeframes Confirming patient41% 28% 31% notifications

Proficiency Dimensions Where NYS Physicians Were More Confident Limited(1) Fair (2) Good/Ex(3/4) Asking patients about any 13%24%63% same-sex partners Asking married patients 14%23%62% aboutpartners outside the marriage

Proficiency Summary Score Created* * 13 items, Cronbach's Alpha=0.94 Range (computed for respondents who completed at least 12 of 13 items)  LOW (Score Range 12-20)  MODERATE (Score Range 21-32)  MED HIGH (Score Range ) 1252

Proficiency Score by Specialty

Proficiency Score by Volume of STD/HIV Care

Interest in Training (Question Format) D7a. Interested in Your Current Proficiency Level additional Limited Fair Good Excellent training? P1  1  2  3  4  1  P2  1  2  3  4  1 P3  1  2  3  4  1

Interest in Training 51% of respondents were interested in training on at least one of the 13 PN proficiencies Interest in training on the proficiency dimensions ranged from 18% - 35% across all respondents

Interest in Training Highest interest in training on: 35%Calculating correct time period for which partners should be elicited 34% Describing services available through the health department’s partner notification program 28%Coaching patients on effective ways to approach telling partners themselves Lowest interest in training on: 18%Asking about same- sex partners 19%Asking about partners outside marriage

Interest in Training Varied By Level of Individual Proficiency Rating: Less skilled = most interested for all proficiencies (p<0.001)

Interest in Training Varied By Level of Individual Proficiency Rating: * %Interested in training who self-rated as: Limited FairGood/Ex Training Topic Describing services available44%37%10% through HD PN program Calculating correct time period for52%43%16% which partners should be elicited Asking married patients about29%32%11% partners outside marriage * (p<.001) for all 13 proficiency dimensions

Interest in Training Varied Somewhat by Specialty* % Interested in training by Specialty OB/GYN EMFP/GP IMPEDS Training Topic Expl. imp. of notifying13%15%19%21%31% exposed partners Asking about same-sex11%15%16%18%28% partners Asking for addl. partner36%15%23%27%25% locating/identifying info Confirming patient15%13%23%24%34% notifications * Differences significant at the p<.05 for these 4 areas only

Interest in Training Somewhat Lower* in Highest Volume Providers Volume of STD Care Low MedHigh % interested in training on Describing services 37%38%25% available through the health department’s PN program Confirming patient26%24%15% notifications Establishing specific 31%28%17% PN plan w/contracted timeframes * Differences significant at the p<.05 level for these 3 areas only

Separate Question on Interest in Additional Information on Best Practices Related to PN 89% of physicians were interested (50% “very”, 39% “somewhat”) in additional information on best practices related to partner elicitation/notification

Prior Contact With and Impression of Health Department PN services Of those (44%) who had referred patients to/ been contacted by HD: 83% had favorable impression of health department PN assistance program

Discussion: Study Limitations Self-rated proficiencies are physician self-perceptions, not actual measures of competence or skill While respondents did not differ on key characteristics from non-respondents, 61% response rate places some limits on generalizability

Discussion: Conclusions Most NYS physicians want to learn more about best practices in partner notification Sizeable minority interested in training on specific PN proficiencies Survey provides useful information to tailor training content and audience (e.g., EM had 2 nd highest STD patient volume but lowest proficiency)

Discussion: Implications Findings support the need: to strengthen linkages between health department PN services and physicians for ongoing evaluation of relative proficiency and effectiveness of different types of providers engaging in various stages of partner elicitation and notification (e.g., health department specialists, medical providers, CBOs)

Discussion: Planned Follow-up NYS STD/HIV Prevention Training Center (PTC) is one of four PTCs providing CDC Partner Services training nationwide Other PTCs offer clinical and behavioral training PTCs continue to work on integrating partner services training into the many clinical training events provided through the NNPTC network (e.g., Eastern Quadrant TOT module)

For Further Information: Rosalind Thomas, Research Scientist NYSDOH Bureau of STD Control & NYS STD/HIV Prevention Training Center (518) Co-Authors: F Bruce Coles, SueAnne Payette (Same Affiliation) Haven Battles, Karyn Heavner, James Tesoriero, Shu-Yin John Leung & Kirsten Rowe NYSDOH AIDS Institute Office of Program Evaluation and Research

Presentation Notes Analyses for this Presentation: Use weighted data (stratified sample by 4 regions of NYS) Include only those respondents (86%) who actually treated STDs/HIV in last year* * Results included in conference abstract included entire sample