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)

LinkedIn ThreadDecember 2014

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

EditorialFebruary 2015

Clap! for Better CommunicationJanuary 12, 2015 7:30am

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.

Thank You!

Any comments/ questions?