Provider and contract referral for bacterial STIs: two sides of the same coin? Exploring the clinical practice and attitudes of sexual health advisers Merle Symonds on behalf of Spread the Word team. Partner Notification in UK. Partner notification a core element in STI control
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Provider and contract referral for bacterial STIs: two sides of the same coin?Exploring the clinical practice and attitudes of sexual health advisersMerle Symondson behalf of Spread the Word team
Index patient benefits
Public health benefits
Reduction of onward transmission
Targeted testing has high yield
50% chlamydia contacts, 65% gonorrhoea contacts will test positive
By contrast, 3% of a population sample will test positive
Faldon.C et al. The Manual For Sexual Health Advisers
“I suppose on the first offering [it’s about] reading how they feel about letting someone know, really, and getting a feel. But I would like to give people the opportunity to refer themselves [patient referral]. I think the outcome is better for them”
“The PN we offer is very much dependant upon the condition [diagnosis] of the patient. Mostly we favour a provider referral just to take on ourselves and hopefully its going to get a better outcome as a result…Index patient referral, we generally try not to…and that generally seems to be the better one that the staff and patients prefer”
“The provider referrals, I think are by far…this is also an urban [metropolitan] clinic, so by far the preferred…I actually tend to do those more for the blood borne infections, particularly with MSM. HIV is one that I’m much more likely to engage that.”
“I wouldn’t say that the culture of my clinic was necessarily provider referral. That’s for me….because I know that I can get everything done. Having done the gay men’s clinic for quite some time in various long spells, and that’s where the vast majority of provider referrals come from. You’re talking 20 or 30 people per patient. And it’s me. Yeah, it becomes a mission, actually. I start making charts of them all. So yeah, there’s some personal difference and I think that’s experience."
“The only time I know that’s been used in my clinic has been around HIV patients and usually that process has begun as generated by the HIV team staff, so everyone has got a hand in it”
“We do when there's a fragility, a psychological vulnerability around the impact of that diagnosis. But I can sense that actually it's important that they do tell their partner, they want to tell their partner but... just can't quite work it out at this point and they need more time to absorb it and think about it.... you can see that they're processing something and it's not the same as they're being resistant but actually just trying to work out how they're going to navigate it and negotiate it. So often I will say to them, 'Well, why don't we set a timeframe here and maybe buy like two or three weeks. If I follow you up, maybe by that point you'll have got to this stage,' and then I follow them up”,
“I think if they rang back and they were...I know we talked about Provider referral, but I think I would prefer to do an Index patient one, then I would say, 'That's fine.' And I'd asked them what had made them change their mind... and then I would probably turn them over to maybe a Contract and say, 'I'll give you two weeks. See how you get on and then I'll give you a call,' and frame it that I was just checking to see how they were getting on. And then if they'd been able to do it, then good. If not, then I think I would say maybe, 'It's not too late to go back to a Provider.”
“...we tell all our patients that we will call them in a couple of weeks' time just to see how they are and we wrap it round saying, 'Did you have any problems after the tablets? Were you okay?' ...But we always tell them [in advance] and say, 'And then we can see how you're getting on with telling your partners.' So, in a way, the Contract referrals are implicit in the normal way that we work because of the checking we do at two weeks. If they haven't been able to do it then, then we'll [offer Provider referral]”.
“You usually know quite soon if they're happy to let an individual know. Or they might be happy to let one know and not quite sure about another one. So for me, it's one to one with that individual. And also you kind of know if they're telling the truth to me and so everyone would be followed up and it's on that follow-up call for, say, Chlamydia, two weeks down the line, to actually talk to them and...re-assess the situation. If then they've had problems you do Provider referral”