Partner Notification for the National Chlamydia Screening Programme: a Service Evaluation

1. Partner Notification for the National Chlamydia Screening Programme: a Service Evaluation Gill Bell Nurse Consultant Sexual Health Adviser SSHA Conference 2008

2. Background • PN process and outcome data collected from all sites by NCSP • National standard for PN = 0.4 - 0.6 partners clinician confirmed treatment per case (0.4 for London/ large cities) • Wide range of outcomes for across sites for 2006-7 (0.03 – 0.77 partners per case with clinician confirmed treatment)

3. Study Aims • To explore reasons for disparity in PN outcomes between sites • To identify interventions which may improve PN outcomes

4. Study design • Visits to eight sites with range of outcomes • Taped, semi-structured interviews with staff responsible for PN and / or Co-ordinators/ Programme leads. Qualitative analysis. • Review of PN data submitted to NCSP. Quantitative analysis

5. Study sites in rank order of partner notification outcomes: clinician confirmed partners treated per case 2006/7

6. Percentage partners treated

7. Factors affecting PN outcomes Findings • PN process – data recorded; provider referral; follow-up; verification • Staff resources – time, skills, attitudes • Service structure – centralised management • Patient / population characteristics - mobility, relationship patterns, attitudes, values

8. Recording names / PN outcomes

9. Recording names • “I make it clear that, if you give me that person’s name, I won’t contact them without your permission” [C] • “ If they were looking uncomfortable I certainly wouldn’t push them, but I would explain ‘Listen, this is going no further, it just makes it easier….so I can treat them” [F] • “ The first one said ‘I’m not going to give you his name!’. So I made it a policy not to ask” [G]

10. Provider referrals per case

11. Provider referrals • “Some don’t feel happy to tell somebody…if they want us to we do offer to contact that partner” [E] • “ I will explain the methods we use to get partners in, and that the onus doesn’t always fall on them” [C]

12. Provider referral: difficulties • “ Sometimes they just don’t want you to go there…in small groups they can be easily identified even without names and they are worried about rebound” [D] • “They can be quite aggressive at first and I do think that is purely shock and being a little bit afraid…and..still a bit of stigma going on…so they get aggressive to us because we are the ones saying you may have come into contact with an infection” [E]

13. Provider referral: rewards • “ He had eight contacts and we got six of them and I was really chuffed with that!” [A] • “ I love it! I do get a lot of satisfaction…especially when you get somebody you’ve been chasing!” [E]

14. Patient follow -up /PN outcomes Patient follow -up /PN outcomes

15. Follow-up comments • “ I say ‘I haven’t had any contact yet, is it alright if I give them a call?’…..they are fine with that because it takes the burden off them” [C] • “ I don’t know how much badgering you can do of a person” [F] • “I’ve got a load there of follow-ups since six weeks ago!” [G]

16. Verification of partner treatment

17. Staff resources • Attitude to clients • Skills – PN experience; sexual health background; training • Time – staffing levels, priorities • Support – colleagues; GUM; PCT

18. Attitudes to young people • “I like working with the younger end….because of the opportunities to put them on the right path and ..it’s a bit more fun” [c] • “Our job’s made easier because they are very good”[A] • “You get a lot of stick from them really” [E]

19. Training • “Thrown in at the deep end but just had to get on with it!” [G] • People without any background or training have just leapt on and had a go!” [D] • “We train ourselves PN. Its monkey see monkey do, unless you are a trained health adviser” [A]

20. Learning PN • “ It was with [colleagues’] support really….when they listened they’d say ‘maybe you’d have got a bit more ..if you put it like this…” [E] • “ We had the personal links…so…we’d ring GU and say ‘what would you do?’” [D]

21. Staffing levels • “Being skimmed back ….by staff with no understanding of what is involved…because it can look quite easy from the outside” [D]

22. Competing priorities • “ The focus of the programme was screen, screen, screen! We could get really entrenched in doing this (PN)” [H] • “ I am not doing PN properly…just fitting it around what I am doing. …The PCT have their targets they want me to meet” [G]

23. Service structure / organisation • Centralisation of PN management • Clear roles and responsibilities re PN • Efficient patient/ partner tracking system • Efficient data recording and entry system • Close links with other local PN services (GUM or CSO)

24. Centralised partner notification management

25. Centralised / telephone management of partner notification

26. Decentralised partner notification management

27. Centralised management of PN

28. Summary of findings • PN processes leading to successful outcomes include: recording partner details, provider referral; follow-up; verification • Adequate staffing levels, training and support essential • A positive attitude towards clients associated with good PN outcomes • Centralised management structure benefits PN outcomes, although may not be feasible as screening volumes increase