W hat Do Physicians Know and Want to Learn about STD/HIV Partner Notification?

1. What Do Physicians Knowand Want to Learn aboutSTD/HIV Partner Notification? National STD Prevention Conference Philadelphia, PA March 8, 2004

2. 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

3. 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

4. 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)

5. Description of Respondents Medical Specialty

6. Description of Respondents

7. How proficient did physicians feelthey were at key partner elicitationand 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)

8. Lowest Rated Proficiency Dimensions Among NYS Physicians Limited(1) Fair (2)Good/Ex(3/4) Describing services available 47% 30% 23% through HD PN program Asking for addl. partner 46% 28% 26% locating/identifying info Establishing specific plan 45% 31% 24% with timeframes Confirming patient 41% 28% 31% notifications

9. 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% about partners outside the marriage

10. Proficiency Summary Score Created* • LOW (Score Range 12-20) • MODERATE • (Score Range 21-32) • MED HIGH (Score Range 33- 52) 12 52 * 13 items, Cronbach's Alpha=0 .94 Range 12-52 (computed for respondents who completed at least 12 of 13 items)

11. Proficiency Score by Specialty

12. Proficiency Score by Volume of STD/HIV Care

13. Interest in Training (Question Format)   D7a. Interested in Your Current Proficiency Level additional Limited Fair Good Excellent training? P1 q1 q2 q3 q4 q1 P2 q1 q2 q3 q4 q1 P3 q1 q2 q3 q4 q1

14. 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

15. 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

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

17. Interest in Training Varied By Level of Individual Proficiency Rating: * %Interested in training who self-rated as: LimitedFairGood/Ex Training Topic Describing services available 44% 37% 10% through HD PN program Calculating correct time period for 52% 43% 16% which partners should be elicited Asking married patients about 29% 32% 11% partners outside marriage * (p<.001) for all 13 proficiency dimensions

18. Interest in Training Varied Somewhatby Specialty* % Interested in training by SpecialtyOB/GYNEMFP/GPIMPEDS Training Topic Expl. imp. of notifying 13% 15% 19% 21% 31% exposed partners Asking about same-sex 11% 15% 16% 18% 28% partners Asking for addl. partner 36% 15% 23% 27% 25% locating/identifying info Confirming patient 15% 13% 23% 24% 34% notifications * Differences significant at the p<.05 for these 4 areas only

19. Interest in Training Somewhat Lower* in Highest Volume Providers Volume of STD Care LowMedHigh % interested in training on Describing services 37% 38% 25% available through the health department’s PN program Confirming patient 26% 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

20. 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

21. Prior Contact With and Impression ofHealth 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

22. 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

23. 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 2nd highest STD patient volume but lowest proficiency)

24. 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)

25. 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)

26. For Further Information: Rosalind Thomas, Research Scientist NYSDOH Bureau of STD Control & NYS STD/HIV Prevention Training Center (518) 474-3598 (rpt01@health.state.ny.us) 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

27. 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