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					  Outreach Partner
Notification 5 years on
    Linda Lewis
Senior Health Adviser
                        Carlton Street Clinic
                        27 – 29 Carlton Street
                        Blyth
                        Northumberland
                        NE24 2DT
About Northumberland
  – Over 2,000 square miles
  – Largest county in England
  – Diverse population
History
The beginning
•2003-2004
•December 2003 Commenced at Northumberland
    – Setting up GUM service
        • working with lead nurse to develop GUM Service

    – GP Questionnaire re Sexual Health Strategy
        • Identified over 8o% GP Practices were prepared to undertake sexual health
          screening but only 10% would undertake partner management.

    – Discussion with local laboratory re feasibility of sending copy
      reports to HA
2004
Commencement of Outreach Chlamydia Partner
 Notification Pathway
   – Overall aim:-
      • to offer all patients within Northumberland who test positive for
        Chlamydia the same follow-up care and management as those who
        attend a GUM service, and therefore reduce the number of
        untreated infections in the sexually active population.
• Initially this was outreach only with HA contact via
  telephone / letter. Referring those who needed further
  screening etc to nearest GUM.
• From April 2004 offering HA service for all GUM clinical
  sessions both at base and outreach clinics
history
• 2004
   – Collaboration with Clinical Governance in developing
       • Leaflets
       • Care pathway

   – Working with Secondary Care provider
       • identification of link person
       • training

   – Road shows in the 4 geographical areas
       • Raising awareness of GUM service
       • Raising awareness of STI’s
       • Introducing Chlamydia Care Pathway

   – Mail shot to all primary and secondary service providers
2004
• Lab reports received in accordance to
  previous provider service

• April Formal pathway commenced
  – All hospital reports acted upon
  – Majority of remaining reports not acted upon
     • Unable to get permission from referrer
   over 45% of reports were not acted upon
process
• Positive Chlamydia lab result
  – Set recall date
     • 1 month
     • 2 weeks if pregnant

• If no referral contact referrer
  – Letter (review 1 month)
  – Telephone (review 2 days)
  – E-mail (review 2 days)
Depending on outcome
• Contact patient by chosen method
  – Telephone
  – letter

• Discussion to include
  –   Treatment
  –   Compliance
  –   Partners (identifying sexual activity to ensure appropriate rx)
  –   Safer sex
  –   Offer further sti screen
2004 and 2005 lab reports
2004 and 2005 testing sites (male)
2004 and 2005 testing sites (female)
2004 reason for test
  female




                  25% re-infection
2005 reason for test
                                                       male

                                                  0


                                          30%                    symptoms
                                                       35%
                                                                 C4a contacts
                                          7%
                                                                 STI screen
                                                 28%
                                                                 no clinical

  20% possibility of re-infection (10 patients not aware of diagnosis)
2004
 Partner Notification Management difficult
    Lone HA
    Time constraints
    Problems contacting referrer
 Over 10% of patients did not know their diagnosis
 and of the remaining a further 15% were at risk of
 re-infection
2007and 2008 lab reports
2007 testing sites
               female                         male

          11
                                          3
     40                                               GP
                        GP
                        WGH gynae                24   HMPYI
53                      WGH ante
                186                  23
                        Other hosp                    Other
                                                      hosp
2007 reason for test
                                         male

                                                symptoms
                        8
                                          17    C4a
                                                Contacts
                  13                            STI screen

                                                no clinical
                                    12
                                                data
                   4 not actioned
2008 testing sites
          female                         Male


                                     4
     50                                         GP
                   GP
                                10
                   WGH ante
35                                              HMPYI
                   WGH gyna
          190      Other Hosp                   Other
                                          41    hosp
2008 reason for test
               female                          male

                        symptoms
                                                      symptoms
          18                               7
                        C4a
     36
                        contacts      6         21    Contact
                        Procedure                     C4a
40                                                    No clinical
                164
                        STI screen                    Data
     26
                                          21          STI screen
                        No clinical
                        Data
2007 Index Patient Management
Male
  – GP
       •   29 were initially treated by GP
       •   3 were referred directly to GUM and treated
       •   3 DNR to HA letter
       •   1 attended GUM for retreatment
  – HMPY
       • 3 were treated by HMPYI (no PN activated)
• However 13 GP’s DNR (unable to action
  further) and 2 moved out of area
2007 Index Patient Management
• Female
  – 78 were not treated by initiating test site
     • 24 WGH gynae
     • 31 WGH antenatal
     • 23 GP
• Treatment given
  – 32 GP (hospital index patients)
  – 37 GUM
• 4 index patients DNR and remainder moved
2007 Female PN outcome
• 3 retreated by GUM
• 2 retreated by initiating test GP
• 1 aware of diagnosis but not treated at time
  of contact
• 9 not aware of diagnosis
2008 IP female management
•   9 were not aware of diagnosis
•   9 were aware but not treated
•   12 needed retreatment by GUM
•   17 needed retreatment form GP
2008 IP male management
• 2 were not aware of diagnosis
• 1 needed retreatment by GUM
Female Partner management
• 154 IP gave partner details
  –2x3
  – 11 x2
  – 140 x 1 giving total of 168
     • 54 attended GUM
     • 93 attended GP
  – 4 were informed by HA
  – 3 informed by IP
  – 2 needed retreatment
Male partner management
• 21 patients identified 25 partners
  – 4 attended GUM
  – 18 attended GP

  – 4 follow up undertaken by other gum
  – 6 follow up undertaken by HMPYI
Thoughts
Increasing number of GP screening and
  treating C4a
  what about other infections?
more proactive screening prior to coil and
  other procedures
Should we as Health Advisers be looking
  outside the “box” of GUM?

				
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