1. Provider Notification Audit - Implications for Practice Fiona Johnston, Outreach Nurse Richard Williams, Lead Health Adviser Western Sussex Hospitals Trust

2. Provider Notification Definition Background Rationale Recording Audit

3. 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

4. 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

5. 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

6. Recording provider notification Index clinic number DiagnosisDateContact detailsActionResultOutcome 1M11-1C402/01/2011Ashleigh, 18 yo, Worthing, Mob: 0780… Phoned 03/01/11 tci 2/7C4 05/01/11 New V 2F11-20B105/01/2011Gary, 25 yo, Worthing, Mob: 0778… Phoned 09/01/11 tci next week I 3M06-300A108/01/2011Sean, 35 yo, Worthing, Address….. Letter sent 15/01/11A2 31/01/11 New V 4F08-2066C413/01/2011Dan, 22, Worthing, Mob: 0778... Phoned 18/01/11 number unobtainable U 5F11-400C420/01/2011Jack Jones, 18 yo, Worthing, Mob: 0778… Already on databaseC4 02/01/11 Already Att V

7. Audit – Infection and Numbers Chlamydia 60 provider referrals in 2010

8. 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?

9. Methodology Offering/obtaining provider referrals Number of provider referrals Total numbers diagnosed = Provider referral rate (PRR) Source of provider referrals by age, sex, ethnicity Securing attendances Provider Referral Attendances Numbers eligible = Provider referral attendance rate (PRAR) Attendances by age, sex, ethnicity

10. Chlamydia Provider Referral Rate (PRR) - Total Positive Diagnoses Number of PRs PRR Total365600.16

11. Chlamydia Provider Referral Rate (PRR) by Sex Positive Diagnoses Number of PRs PRR Male193200.10 Female172400.23 Total365600.16

12. Chlamydia PRR by age range: Male NumberPRsPRR 16-192440.16 20-248790.10 25-346060.10 35-441710.05 45+50- Total193200.10

13. Chlamydia PRs by age range: Female NumberPRsPRR U163-- 16-1959160.27 20-2463100.16 25-343540.11 35-44920.22 45+382.66 Total172400.23

14. Chlamydia Provider Referral Attendance Rate (PRAR) - Total PRsNew VIAlready Attended V UPRAR Total6024166140.60 (24/40)

15. Chlamydia Provider Referral Attendance Rate (PRAR) by Sex Number of PRs New VIAlready Attended V UPRAR Male401612390.57 (16/28) Female2084350.60 (8/12) Total6024166140.60 (24/40)

16. Chlamydia PRAR by Age Range Inadequate data

17. 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

18. 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

19. 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)

20. 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)