Assessing Training Needs Related to the Care of Sexually Transmitted Diseases (STDs)

1. Assessing Training Needs Related to the Care of Sexually Transmitted Diseases (STDs) Perspectives of Medical Providers Working Among American Indian and Alaska Native Populations (AI/ANs) Cheryl Mason, MPH, Laura Shelby, BA, Rachel Pacheco, RN Indian Health Service, National Epidemiology Program, Albuquerque, NM ■ Sharon Adler, MD, MPH, Jolie Pearl, RN, MPH California STD/HIV Prevention Training Center, Berkeley, CA ■ Teri Anderson, MT Denver STD/HIV Prevention Training Center, Denver Public Health, Denver, CO ■ Candace Nelson, MA Kaiser Permanente, Denver, CO

2. Background • From 1996 to 2002, Chlamydia rates among AI/AN were consistently 3 times that for non-AI/ANs • From 1989 to 2002, rates for gonorrhea, primary & secondary syphilis declined among AI/ANs but at markedly lower rates than that for non-AI/ANs

3. Background (cont.) • Assess STD training needs among medical care providers working with AI/ANs • Content areas evaluated: • Skills needed or challenges in STD care • Training logistics • Learning modalities

4. Methods • Sampling • Convenience sample • 14 healthcare facilities • 63 in-person structured interviews • Data analysis • Transcripts analyzed using ATLAS*ti • Data coded by major content areas and common themes • Common themes reported

5. Common needs or challenges in STD Care • Prevention • Diagnosis • Treatment • Partner management

6. Common needs or challenges in prevention • Patient education is a challenge • Need effective patient education tools • good pamphlets or educational material • pass onto patients • addresses risks

7. Common needs or challenges in diagnosis • Training on “less prevalent” or “rare(r) diseases” • syphilis • chancroid • Training on diagnosis updates • Training on HIV/AIDS

8. Common needs or challenges in treatment • Training on HIV/AIDS • Difficulty in locating patients is a challenge • getting people in for follow-up/testing • finding them after a positive test • Training on treatment updates

9. Common needs or challenges in partner management • Getting partners into clinics is a challenge • Prescribing medications for partners is a challenge • tempting to just give a prescription for the partner...but dangerous legally and medically • how do you cover and protect your patient and that partner? • Locating partners is a challenge

10. Training logistics • Previous training & duration of training • Factors influencing training attendance

11. Previous training & duration of training • Previous training • General medical training, 71% (n=45) • STD-specific training, 18% (11) • Duration of training • Previous trainings attended lasted 1-5 days • Ideally, general medical training should last 2-3 days • Ideally, STD-specific training should last 0.5-2 days

12. Factors influencing training attendance • Funding and time allocated • Funding varies by facility and provider type • Average physicians’ annual training funds, $1500 • Average non-physicians’ annual training funds, $500 • Allotted 1 week of ‘educational’ leave • Onsite v. offsite • 65.1% (n=46) preferred ‘onsite’ training • Definition of ‘onsite’ varies by location of facility • CME/CEU credits and advance notice are essential

13. Learning modalities • Best available learning modalities • Desired learning modalities • Computer-based learning

14. Best available & desired modalities

15. Computer comfort level • Most providers & administrators are comfortable using computers • What they like about computers: • Quick, easy access to information • Onsite, does not require travel • Offers variety of resource material • What they don’t like about computers: • Too complicated • Crash/too slow • Work solo/don’t benefit from group discussion • No time

16. Computer/Internet access at work • Availability of computers/Internet • 88.9% (n=56) have access to computers • 38.1% (n=24) have access to the Internet • Actual utilization of computers • 23.8% (n=15) actually utilize • 15.9% (n=10) actually utilize, but too busy to do when want • 57.1% (n=36) don’t utilize, too busy • 7.9% (n=5) don’t utilize, lack computer skills

17. Summary • What training is needed? • Updates on diagnosis & treatment (changes/latest techniques) • Emphasis on “rare(r)” diseases (i.e. syphilis and chancroid) & HIV/AIDS • Training logistics • General medical trainings widely attended • Trainings that are onsite, offer CME/CEU, and advance notice are preferred • Training modalities • Lecture/updates/conference is a common way to learn • Although computers are available at work, utilization is difficult

18. Next Steps • Provide training that addresses needs assessment findings • Updates • Rare(r) diseases (i.e. syphilis and chancroid) & HIV/AIDS • When developing training, one should consider: • Incorporating training into existing, widely attended medical conferences • Combine lecture/updates/conference & hands-on training with other desired ways of learning • Computer-based learning has potential, but implementation and acceptance may prove challenging • Further exploration • Provider survey • Determine consistency & strength of these findings in other settings

19. Acknowledgements • Project participants • IHS: James Cheek • PTCs: Kitty Corbett, Mabel Davis, Tom Davis, John Fitch, Alice Gandelman, Maxine Haytin, Terry Lee, Anne Meegan, Kees Reitmeijer, Dodie Rother, Terry Stewart, Debbie Tripp, Stacy Vogan