Partner notification: do patients prefer patient or provider referral?
Partner notification: do patients prefer patient or provider referral? |
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Key words: Partner notification, sexually transmitted infections, Genitourinary Medicine
Introduction
There has been a substantial rise in the diagnosis of acute sexually transmitted
infections (STI) in the United Kingdom since 19951. Partner notification plays
a central role in strategies to prevent the transmission of STIs and in their
management 2. The main aims3 of partner notification are to identify and treat
the sexual contact/s of patients diagnosed with a STI, prevent reinfection,
reduce the pool of infection in the community and thereby decrease the incidence
of infection and the complications associated with untreated STIs.
Three approaches to partner notification are used in the United Kingdom. In
patient referral, when the index patient agrees to inform his or her sexual
partner and where necessary, previous partners to attend a Genitourinary Medicine
(GUM) department for clinical advice, assessment, diagnosis and treatment. In
provider referral, the index patient asks a healthcare professional to notify
sexual partner/s whilst maintaining the patients confidentiality. In conditional
referral, the health care worker obtains information about the index patient’s
sexual partners but an agreement is made to allow the index patient time to
notify the partners first if possible4. There is little known about the current
practice of partner notification in GUM clinics in England and Wales5. The aim
of our study was to ascertain whether patients diagnosed with a STI prefer patient
or provider referral for contacting their sexual partner/s.
Method
A prospective study was commenced in two GUM departments in December 2000 for
a period of 6 weeks. A questionnaire was designed to determine the views of
patients attending these two departments about partner notification. The healthcare
worker completed the questionnaire during the partner notification phase of
the consultation.
The self administered structured questionnaire consisted of seven questions
to determine whether patients diagnosed with Chlamydia, gonorrhoea, non-gonococcal
urethritis, genital herpes and genital warts would prefer to contact partner/s
themselves (patient referral) or have assistance from GUM staff (provider referral).
All patients diagnosed with these infections were asked to enrol in the study.
Information was obtained as follows: - gender, sexuality, diagnosis, preference
for patient or provider partner notification, number of traceable sexual partners
seen within three months, area of partner’s residence and how many traceable
sexual partners were seen and treated.
Results
Completed questionnaires were received from 80 partner notification consultations
in clinic one (Portsmouth) an 80% response rate and 23 in clinic two (Isle of
Wight) a 46% response rate. The age range for patients in clinic one was 16
to 55 years and in clinic two 14 to 50 years. In clinic one 74 (96%) of subjects
were heterosexual and 6 (4%) homosexual in clinic two 21 (91%) heterosexual
and 2 (7%) homosexual. In clinic one 80% (64) of patients were male and 16 (20%)
female in clinic two 9 (39%) male and 14 (61%) female. Diagnoses are shown in
table one.
In clinic one, 137 sexual contacts were identified, (range 1 to 8 partners per
index patient). Forty-four (37%) sexual contacts were untraceable. In clinic
two 28 sexual contacts were identified, (range 1 to 4 sexual partners per index
patient). Two (7%) sexual contacts were untraceable. Partner outcome was known
for 77 (83%) of traceable partners in clinic one and 15 (71%) in clinic two
who were seen and treated. 75 (94%) of index patients in clinic one and 22 (96%)
in clinic two preferred to contact their sexual partners themselves regardless
of the index patients diagnosis, age, gender or sexuality.
Discussion
The most recent partner notification guidance was published in 19806. New guidelines
are in progress. The majority of published studies report disease specific audits
of the effectiveness of partner notification and treatment but do not describe
current partner notification practice7. A recent survey of contact tracing for
STIs in GUM clinics showed patient referral to be the most popular method.5
Interviews undertaken by NOP8 with a small number (17) of participants in the
Department of Health (DoH) Chlamydia screening pilot study reported that subjects
found notifying partners particularly problematic. Several respondents in the
DoH Chlamydia pilot study said they would have preferred the staff in GUM to
contact their ex partners rather than do this themselves. This has not been
the experience of staff working in the Portsmouth and Isle of Wight GUM departments.
In this study the majority of patients (>93%) preferred to inform traceable
sexual partners themselves of their diagnosis and subsequent need to attend
a healthcare setting to obtain treatment and further management. The response
rate to the survey was higher in clinic one than clinic two, a contributing
factor may be because there were staffing problems in clinic two during the
study period. Known outcome for traceable sexual partners was lower in clinic
two; this may be because of the transient nature of people in the geographical
area in which the clinic is situated. In addition there is a ‘close knit’
community on the IOW and therefore local people may choose to attend a GUM department
anonymously on the mainland.
Unlike the Chlamydia screening pilot study8 this data and several other studies4,5,7
indicate that the vast majority of patients find patient referral both acceptable
and effective and it is the preferred method of partner notification in the
UK. A recently published study9 undertaken in central Africa indicates that
patient referral of sexual contacts with a STI is highly acceptable and very
effective at identifying and treating partners of people diagnosed with a STI.
For patient referral techniques to be successful it is essential that the method
is highly acceptable to patients and that all staff working in the GUM department
are provided with appropriate training to ensure that they are able to discuss
partner notification issues where relevant.
Table One: Patients diagnoses
References
Correspondence:
Mrs L J Tucker, Clinical Nurse Specialist, Department of Genitourinary Medicine,
St Mary’s Hospital, Milton Road, Portsmouth, Hampshire, P03 6AD.
Acknowledgements:
Thank you to all the staff and patients at both departments who contributed
to the data collection.
©2002 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough,
UK
ISSN 1469-7556
http://www.sexualhealthmatters.com.