Provider Notification Audit- Implications for Practice

Fiona Johnston, Outreach NurseRichard Williams, Lead Health Adviser

Western Sussex Hospitals Trust

Provider Notification

• Definition

• Background

• Rationale

• Recording

• Audit

Definition

The active process of a health care professional tracing a sexual contact is known as a ‘provider referral’

Manual for Sexual Health Advisers, 2004

Rationale

Not offering an effective provider referral service will result in many people not being contacted and warned of the risk to their sexual health

Manual for Sexual Health Advisers, 2004

Background

• Contagious Diseases Acts, 1864-69• Emergency Regulation 33B, 1942• Tyneside scheme, 1937• Wakefield scheme, 1948• Pilot study at the London and St Thomas’ hospitals,

1964• National Health Service (VD) Regulations, 1968

• Handbook on Contact Tracing in Sexually Transmitted Diseases, 1980

Recording provider notification

Index clinic number

Diagnosis Date Contact details Action Result Outcome

1 M11-1 C4 02/01/2011 Ashleigh, 18 yo, Worthing, Mob: 0780…

Phoned 03/01/11 tci 2/7 C405/01/11

New V

2 F11-20 B1 05/01/2011 Gary, 25 yo, Worthing, Mob: 0778…

Phoned 09/01/11 tci next week

I

3 M06-300 A1 08/01/2011 Sean, 35 yo, Worthing, Address…..

Letter sent 15/01/11 A231/01/11

New V

4 F08-2066 C4 13/01/2011 Dan, 22, Worthing, Mob: 0778...

Phoned 18/01/11number unobtainable

U

5 F11-400 C4 20/01/2011 Jack Jones, 18 yo, Worthing, Mob: 0778…

Already on database C402/01/11

Already Att V

Audit – Infection and Numbers

• Chlamydia

• 60 provider referrals in 2010

Audit

• How effective are health advisers at offering/obtaining provider referrals?

• Who is making the provider referrals?

• How effective are health advisers at securing attendances?

• Who is attending following a provider referral?

Methodology

• Offering/obtaining provider referralsNumber of provider referralsTotal numbers diagnosed

= Provider referral rate (PRR)

• Source of provider referrals by age, sex, ethnicity

• Securing attendancesProvider Referral AttendancesNumbers eligible

= Provider referral attendance rate (PRAR)

• Attendances by age, sex, ethnicity

Chlamydia Provider Referral Rate (PRR) - Total

Positive Diagnoses

Number of PRs

PRR

Total 365 60 0.16

Chlamydia Provider Referral Rate (PRR) by Sex

Positive Diagnoses

Number of PRs

PRR

Male 193 20 0.10

Female 172 40 0.23

Total 365 60 0.16

Chlamydia PRR by age range: Male

Number PRs PRR

16-19 24 4 0.16

20-24 87 9 0.10

25-34 60 6 0.10

35-44 17 1 0.05

45+ 5 0 -

Total 193 20 0.10

Chlamydia PRs by age range: Female

Number PRs PRR

U16 3 - -

16-19 59 16 0.27

20-24 63 10 0.16

25-34 35 4 0.11

35-44 9 2 0.22

45+ 3 8 2.66

Total 172 40 0.23

Chlamydia Provider Referral Attendance Rate (PRAR) - Total

PRs New V I Already Attended

V

U PRAR

Total 60 24 16 6 14 0.60 (24/40)

Chlamydia Provider Referral Attendance Rate (PRAR) by Sex

Number of PRs

New V I Already Attended

V

U PRAR

Male 40 16 12 3 9 0.57 (16/28)

Female 20 8 4 3 5 0.60 (8/12)

Total 60 24 16 6 14 0.60 (24/40)

Chlamydia PRAR by Age Range

• Inadequate data

Results

• Provider referral rate is 0.16

• Females make more provider referrals than males (0.1 M, 0.23 F)

• Most popular age range 16-19 (0.23 F, 0.16 M)

• Provider Referral Attendance Rate 0.6 (slightly higher for females (0.6) than males (0.57))

• Inadequate information available on ages of recipients of provider referral

Conclusion

• PR most popular for females (0.23)

• Age range 16-19 (0.27)

• Males have far lower PRR (0.10)

• PRAR is high for both males and females

Discussion• Establish standards in provider referral

• Define standards

• Effects

• Focus on ‘breaking bad news’ to enhance partner referral (Coleman and Lohan, 2007)

• Develop adjuncts to partner referral (Trelle et al, 2007)

• Referrer and recipient views (Hogben et al, 2005; Pavlin et al, 2010)

Recommendations

• Develop standards

• Audit – data collection to include recipient ages

• Enhance male provider referral

• Develop adjuncts for provider referral (posters, patient information leaflet)

• Patient satisfaction survey for provider referral recipients

• Enhance partner notification services (breaking ‘bad news’, partner materials, patient information leaflet)