Provider Notification Audit - Implications for Practice Fiona Johnston, Outreach Nurse Richard Williams, Lead Health Adviser Western Sussex Hospitals Trust

Provider Notification Definition Background Rationale Recording Audit

Definition The active process of a health care professional tracing a sexual contact is known as a ‘provider referral’ Manual for Sexual Health Advisers, 2004

Rationale Not offering an effective provider referral service will result in many people not being contacted and warned of the risk to their sexual health Manual for Sexual Health Advisers, 2004

Background Contagious Diseases Acts, Emergency Regulation 33B, 1942 Tyneside scheme, 1937 Wakefield scheme, 1948 Pilot study at the London and St Thomas’ hospitals, 1964 National Health Service (VD) Regulations, 1968 Handbook on Contact Tracing in Sexually Transmitted Diseases, 1980

Recording provider notification Index clinic number DiagnosisDateContact detailsActionResultOutcome 1M11-1C402/01/2011Ashleigh, 18 yo, Worthing, Mob: 0780… Phoned 03/01/11 tci 2/7C4 05/01/11 New V 2F11-20B105/01/2011Gary, 25 yo, Worthing, Mob: 0778… Phoned 09/01/11 tci next week I 3M06-300A108/01/2011Sean, 35 yo, Worthing, Address….. Letter sent 15/01/11A2 31/01/11 New V 4F C413/01/2011Dan, 22, Worthing, Mob: Phoned 18/01/11 number unobtainable U 5F11-400C420/01/2011Jack Jones, 18 yo, Worthing, Mob: 0778… Already on databaseC4 02/01/11 Already Att V

Audit – Infection and Numbers Chlamydia 60 provider referrals in 2010

Audit How effective are health advisers at offering/obtaining provider referrals? Who is making the provider referrals? How effective are health advisers at securing attendances? Who is attending following a provider referral?

Methodology Offering/obtaining provider referrals Number of provider referrals Total numbers diagnosed = Provider referral rate (PRR) Source of provider referrals by age, sex, ethnicity Securing attendances Provider Referral Attendances Numbers eligible = Provider referral attendance rate (PRAR) Attendances by age, sex, ethnicity

Chlamydia Provider Referral Rate (PRR) - Total Positive Diagnoses Number of PRs PRR Total

Chlamydia Provider Referral Rate (PRR) by Sex Positive Diagnoses Number of PRs PRR Male Female Total

Chlamydia PRR by age range: Male NumberPRsPRR Total

Chlamydia PRs by age range: Female NumberPRsPRR U Total

Chlamydia Provider Referral Attendance Rate (PRAR) - Total PRsNew VIAlready Attended V UPRAR Total (24/40)

Chlamydia Provider Referral Attendance Rate (PRAR) by Sex Number of PRs New VIAlready Attended V UPRAR Male (16/28) Female (8/12) Total (24/40)

Chlamydia PRAR by Age Range Inadequate data

Results Provider referral rate is 0.16 Females make more provider referrals than males (0.1 M, 0.23 F) Most popular age range (0.23 F, 0.16 M) Provider Referral Attendance Rate 0.6 (slightly higher for females (0.6) than males (0.57)) Inadequate information available on ages of recipients of provider referral

Conclusion PR most popular for females (0.23) Age range (0.27) Males have far lower PRR (0.10) PRAR is high for both males and females

Discussion Establish standards in provider referral Define standards Effects Focus on ‘breaking bad news’ to enhance partner referral (Coleman and Lohan, 2007) Develop adjuncts to partner referral (Trelle et al, 2007) Referrer and recipient views (Hogben et al, 2005; Pavlin et al, 2010)

Recommendations Develop standards Audit – data collection to include recipient ages Enhance male provider referral Develop adjuncts for provider referral (posters, patient information leaflet) Patient satisfaction survey for provider referral recipients Enhance partner notification services (breaking ‘bad news’, partner materials, patient information leaflet)