1. Development and Implementation of STD Treatment Verification Program in San Francisco L. Fischer, C.K. Kent, J.D. Klausner

2. Acknowledgements SFDPH-STD Prevention and Control Screening and Surveillance Services Sharon Byrd, Health Worker III Yvette Castillo, Health Worker II Robert Kohn MPH, Epidemiologist Tony Tran, Health Worker II

3. Gonorrhea (GC) and Chlamydia (CT) Treatment Reporting Rationale: –Assure appropriate treatment & that treatment occurs San Francisco DPH Challenge: –Find most effective method to get treatment reports State of CA requires treatment reporting on all Confidential Morbidity Reports (CMR): –During 2001, only 1% of all providers reported treatment on CMR, 2% by fax or phone

4. Objective Develop treatment verification program Implement provider reporting utilizing existing staff Evaluate success or barriers to treatment reporting by SF providers

5. Data Reporting Sources Year 2001-2003 reported morbidity Provider Types: 40 SFDPH screening sites 15 County hospital based clinics (SFGH) 70 private and large volume providers Examined GC & CT reported treatment by provider types

6. Questions 1.How complete is provider reporting? 2.What are the provider barriers to reporting? 3.How can we increase treatment reporting with existing staff? 4.How can we help providers improve reporting?

7. Provider Needs Provider Barriers to Reporting: Survey Findings: –Importance –Lack of Staff –Disseminated providers –Lack of understanding reporting requirements

8. STD Prevention and Control Staff Needs Assessment of existing responsibilities What can be streamlined? Duties of existing 3 Health Workers (HW): –4 STD/HIV clinic counseling shifts each per week –Phone results coverage four times per week –Identifying need for field investigations –ICCR/Screening desk coverage –PEP and HIV/PCRS Case Management –Active STD Surveillance and medical records search

9. Staff Training 1.Develop computer program to identify incomplete reports needing follow up 2.Review CMR with staff 3.Develop written polices for staff follow-up including specific time frames 4.Role-Play requests to providers to build confidence in Health Workers 5.Weekly and consistent review of successes and/or barriers

10. Provider Training Letter to all Providers from STD Controller Mass Mailings of: –CA Health and Safety Code reporting requirements –CDC, LHD Treatment Guidelines –Copy of CMR One-One meetings with problem reporters

11. Treatment Reporting Results 2001 – 3% of all providers reported treatment 2002 treatment reporting: –Screening sites: 95% (3295/3462) –SFGH clinics: 25% (99/301) –Private clinics/providers:31% (460/1021) 2003 treatment reporting: –Screening sites: 97% (3553/3674) –SFGH clinics: 58% (255/437) –Private clinics/providers:67% (1009/1497)

12. Conclusions Reorganizing existing staff duties with little disruption to clinic services Commitment of time, effort and consistency for training staff and providers Adopt and maintain a Can-Do attitude with staff and providers

13. Contact Information Address: STD Prevention and Control Services 356 7 th Street San Francisco, CA 94103 Lyn.Fischer@SFDPH.org (415) 487-5518