Chlamydia Care for College Students Competence in Communication Intervention Designed By Chlamydia...
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Chlamydia Care for College StudentsCompetence in Communication
Intervention Designed ByChlamydia Group 2
Molly Lawney, Hasti Mehta, Richard Kintu, and Claire LindsayIn Collaboration with the Boston Public Health Commission
Overview
Boston Rate 1.7 time National
Rate
• Asymptomatic• Serious
comorbiditiesTarget
Population
• Students aged 18-22 years who attend colleges in Boston (on- and off-campus)
Health Behaviors
• Increase screening rates • Increase partner notification • Make college students educated consumers• Encourage providers to talk to college-aged
patients about STIs
Decrease the rates of chlamydia
among college-aged persons in
Boston
Literature Review
“To adequately prevent, reduce, and maintain the likelihood of adolescents' adopting sexual risk behaviors, intervention programs should be designed to address these myriad levels of causation.”
(DiClemente et al., 2007)
Original CC image courtesy of AHRQ
Findings from Literature
• Focus on assessment of current STI knowledge levels and practice patterns.
• Encourage best practices• Create requirements for
“room set-up” to include specific testing equipment
• Peer-led interventions are most effective.
• Focus on developing effective communication skills for discussing STIs with college students.
• Focus on increasing knowledge about chlamydia and changing beliefs about college students’ risk for STIs.
Individual Interpersonal
InstitutionalSocietal/ Political
The Intervention plan
Provider Registration and
Survey
Provider Training Session
Training Evaluation
Survey
Provider/Patient Follow-up Survey
Interactive Peer-Led Training Session for Providers
• Pilot program launched at University of Massachusetts, Boston• UMass Boston’s University Health Services
• Future programs will be available to all health providers in greater Boston at various convenient locations
Registrationpre-training survey
• Registration using mHealth texting application
• Contact information• Health organization they are associated with
• Pre-Training Survey• Results will be used for the knowledge portion
of each training session• Alerts the peer-leader of knowledge gaps and
topics attending providers are well informed of
Provider Training Session Presentation
[Knowledge Base]
Presentation[Effective Communication Methods]
Practice[Mock Conversations]
Feedback
Best Practices
• Interactive training session
• Training led by Peer-Leader (volunteer)
• Pilot program – representative from UMass Boston on Chlamydia Advisory Board
• Additional trainings – providers who have taken the training course
• Each training is 5-10 providers
• Trainings last 2 hours
PresentationKnowledge Base
Results of the pre-test Used to establish the direction of the
training program Used to highlight any topics of sexual
health where knowledge gaps may exist
Presentation Topics Chlamydia Facts Testing Methods Expedited Partner Therapy
• Recommend reducing # of partners or abstaining from sexual activity
• Effective protection methods: male condoms (best), female condoms/cervical diaphragms, dental damso Natural membrane condoms are not
recommended for STI preventiono Use only water-based lubricants
Chlamydia Prevention1
• All sexual partners from the previous 2 months should be treated with EPT or asked to come in for testingo Ask even if patient is in a committed
relationship/married• Stress to index patient that reinfection is likely if
partner is left untreated• EPT should include treatment instructions, medication
warnings, general health counseling, statement advising that partner seek medical evaluation
Partner Management1
PresentationEffective Communication
Effective provider-patient communication methods
Scenarios to be read by the peer leader
Goals: Improve provider understanding of the
importance of communicating with patients about their sexual health
Improve provider confidence in communication methods suggested
• Interactive approach that focuses on tailoring a conversation around the patient’s individual circumstances
• Proven to increase motivation to use or enhance prevention methods
Client-Centered Care2
• DO explain why the testing is helpfulo Risk of harm to reproductive health
(emphasize that Chlamydia is asymptomatic)5
• DO explain how screening might reduce risko Infection can easily be treated5
• DO explain conditions under which screening might not be necessary5
o If risk of infection is very low (i.e. not sexually active)
Dos & Don’ts of Approaching the Topic of Getting Tested for Chlamydia
• DON’T intimidate patients into getting tested for Chlamydia5
o Causing fear will increase patient anxiety, especially among low-risk patients
Do’s & Dont’s of Approaching the Topic of Getting Tested for Chlamydia
The following tactics tend to mitigate patients’ negative responses when delivering a positive chlamydia diagnosis:
• Duration of chlamydia: explaining that the disease could have laid dormant for some time provides an opportunity for alternative explanations as to the source of infection
• Commonality: likening chlamydia to the common cold
• Transiency: describing the ease and speed of treatment
Reducing Negative Response: Emphasizing Duration, Commonality, and Transiency7
Mock conversationProvider Partner Pairs
Partner activity
Scenarios for providers to work through (while videotaped) Communicating a positive chlamydia
diagnosis Asking a patient about sexual partners Asking a patient about their general sexual
health Possible reaction situations
Pairs will share their video to the group
Group discussion around common experiences in practice
DiscussionBest Practices
Providers share out their clinic’s best practices around sexual health
Group discussion around building a plan to implement better practices
Make an action plan for what is needed in their clinic to provide better sexual health care
• Location of testing materials• Expedited Partner therapy
o Barriers and solutions?
• Adding sexual health items to medical charts
• SMS reminders to patients for annual testingo SMS reminders to patients who test positive to
return for re-test after 3 months
• Providing online test-kit order system
Policy Suggestions
Program materialsClinic Implementation
• Patient’s Guide to Sexual Health • For immediate implementation• Information for patients:
• STI facts• Prevention methods• Testing recommendations• Testing locations• Top ten questions to ask your healthcare provider regarding
sexual health
• Communication Strategies for Sexual Partners• Cards provided to college aged patients• Strategies for communicating with sexual partners
• The importance of getting tested• A positive diagnosis
Communication Strategy
Target Audience Objectives
Healthcare Professionals
Inspired to register for the training
Healthcare Administrators
Inspired to mandate that organization staff register for the training
Net impression
Believe that this training will fill that
gap
Feel invested in their college
patients
Feel a sense of action and
empowermentWant to learn to
communicate better with
college patients
June 2014
• Letter to the Editor in Op Ed section of The Mass Media
July 2014
• Launch registration page for full-scale intervention
August 2014
• Run pilot program at UMass Boston
November 2014
• Results of pilot evaluation analyzed
• Media Advisory to clinic & college newspapers, Boston Globe, & WBUR
Communication PlanTimeline
December 2014
• Press Release to radio, television, & print media
January 2015
• Pitch Letter to WBUR’s Radio Boston
February 2015
• Blog post on “In Practice” by Suzanne Koven, MD
April 2015
• First run of full scale provider training
• Thread on Boston Healthcare Professionals LinkedIn group
•Press Event at UMass Boston
Communication PlanTimeline (Continued)
Chlamydia Care for College Students: Competence in Communication, an initiative of the Boston Public Health Commission (BPHC)
Chlamydia Care for College Students: Competence in Communication, an initiative of the Boston Public Health Commission (BPHC), is a physician-led, interactive training to improve Boston providers’ skills at discussing chlamydia prevention, testing, diagnosis, and treatment with college student patients. Providers who have taken the training are encouraged to comment on this thread and discuss how the training has affected your practice. Providers who have not taken this training are welcome to join the discussion and ask questions about the program. For more information: http://bphc.org/providertraining
Sandra RamsyPhysician UMass Boston, Member of Boston’s Chlamydia Advisory Board
12 people like this
5 comments
Boston Healthcare Professionals 5,697 members
Robert Garrison, MSN Beth Israel Deaconess HospitalHas anyone taken this training? Is it for continuing ed credit? Did you find it useful?
Robert, the training does not count for CMEs, but you would be listed on the BPHC Preferred Provider list, which could encourage new patients to seek your care. I took this course in its pilot form and it really transformed how I discuss STIs with college students. I find myself testing far more students because I’m more confident about bringing up the subject with them. I have also noticed that since I took the training, a lot more of our students (I’m at UMass Boston) have been coming in for STI testing. I think it’s a combination of being part of the Preferred Providers list and from patient referrals!
Cynthia Rice, MD UMass Boston Health Services
Comments
James Leigh, DO Boston Medical Center
Ruby Dwyer, MD Tufts Medical Center
I’m thinking about taking the training since most of my patient’s are college-aged youth. Do you think the training is effective at helping you approach the topic of sexual health less awkwardly with youths? I’m hoping that this training will help me get them to open up and talk freely with me so I can recommend appropriate testing/treatment options.
James, I had a similar problem with my college-aged patients. After the training, I was able to use the skills they provided us with to connect with my patients more effectively. I especially loved that they gave us the chance to apply the skills they taught us during the training. I feel like I am so much more confident when talking to youths about STIs and even other sensitive health topics, too.
Pitch letter to WBUR’s Radio BostonJanuary 2015
Announce success of pilot & launch of full-scale program
List of people to interview
Data from pilot
training
Radio Boston listeners = physicians and laypeople
Need to demonstrate relevance to both
Story not yet told outside of print media
Pitch Letter (Continued)
• 75% of providers reported increased self-efficacy in discussing chlamydia concerns with college patients.
• The number of college students reporting that their providers talked to them about chlamydia at their regular physicals increased 65%.
• Provider knowledge and student knowledge about chlamydia symptoms, rates, testing, and treatment increased 35% and 85%, respectively.
• The number of students who reported communicating a positive chlamydia diagnosis with a previous partner(s) increased 35%.
Pilot training evaluation
data
• Physician who saw need to discuss chlamydia after a patient developed fertility problems from a prolonged case of the disease.
• Physician who since taking the pilot training, feels much more comfortable and confident about discussing chlamydia with her college-aged patients.
• Clinic administrator who noted large influx of new patients after her clinic’s providers took the training due to BPHC’s Preferred Providers’ Network.
• Two students at UMass Boston who got tested for chlamydia for the first time after their providers, who had attended the pilot training, explained the importance of early detection.
Interviewees to help tell
story
Fact sheetJanuary 2015
• Accompanies the pitch letter
• Provides additional information about the program
Clap! For Better CommunicationJanuary 15, 2015 7:30 am
After being a primary care internist for more than two decades, I have been able to follow some of my patients through some of the most rewarding and some of the most challenging times in their lives. A few weeks ago, I was seeing one of my patients, whom I have been with for more than 8 years, for a routine check-up. Reflecting on that visit, I can humbly admit that the check-up was really for me.
As a medical internist, I am supposed to be equipped to deal with any and every health problem a patient brings, no matter how complex, rare, or simple. Whenever I feel like my training could be improved in an area of medical care, I can take a class or ask another physician for guidance. But during that particular visit, I
Editorial (continued)
A few weeks ago, I was seeing one of my
patients, whom I have been with for more
than 8 years, for a routine check-up.
Reflecting on that visit, I can humbly
admit that the check-up was really for me.
Dr. Green recalled, “Prior to attending the training, I wouldn’t ask my patients about their sexual health or risky behavior unless they seemed ‘at risk’ […] it just wasn’t worth the awkward conversation, but now I am completely comfortable and prepared to have those conversations, and my patients are healthier because of it”.
I realized that I am not adequately
prepared to have meaningful conversations
with my patients that address their
questions about sexual health.
My patient base may not be exclusively
college-aged, but if I can provide better care
and prevent any future uncomfortable or
awkward conversations about sexual health
with my patients, then I will be
enthusiastically signing up for an upcoming
training session.
The moment we, as physicians, nurse practitioners, physician assistants, and pharmacists, stop giving holistic care to each and every one of our patients is the moment we stop doing our job.
The medical field is constantly evolving and expanding; we should
be, too.