Development and Implementation of STD Treatment Verification Program in San Francisco

1. Development and Implementation of STD Treatment Verification PrograminSan 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 • How complete is provider reporting? • What are the provider barriers to reporting? • How can we increase treatment reporting with existing staff? • 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 ControlStaff 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 • Develop computer program to identify incomplete reports needing follow up • Review CMR with staff • Develop written polices for staff follow-up including specific time frames • Role-Play requests to providers to build confidence in Health Workers • 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 7th Street San Francisco, CA 94103 • Lyn.Fischer@SFDPH.org • (415) 487-5518