The Hidden Epidemic Confronting Sexually Transmitted Diseases (1997) / Chapter Skim
Currently Skimming:
ESTABLISHING AN EFFECTIVE NATIONAL SYSTEM TO PREVENT STDs
ESTABLISHING AN EFFECTIVE NATIONAL SYSTEM TO PREVENT STDs
Pages 220-302
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 220... ...
, such as a surveillance system to measure STD incidence, public and private sector clinical services, and public education programs, exist in many areas in various stages of development, but these and other components are neither adequate nor coordinated locally, statewide, or nationally. As outlined in the previous chapters, the current strategy for preventing STDs is based primarily on categorical STD programs run by state and local health departments with guidance and funding from the CDC.
|
From page 221... ...
The failure to adequately diagnose and treat STDs or become involved in certain prevention activities, therefore, leads to lost clinical opportunities to prevent STDs, and thus, to incomplete or fragmented clinical services. As discussed in Chapter 5, because health plans do not assume responsibility for those who are not plan members, there is no assurance that sex partners of infected plan members will receive appropriate evaluation and treatment.
|
From page 222... ...
Data presented in Chapters 3 and 4 show that awareness of STDs in the United States is low and misperceptions of risk are common, even among those at highest risk for STDs. This is likely a result of the lack of open public education about STDs and the failure of the mass media to provide accurate information regarding the consequences of high-risk sexual behavior.
|
From page 223... ...
In addition to the professionals mentioned above, health plans, pharmaceutical and medical device companies, educators, and other individuals and entities that have not traditionally been involved in
|
From page 224... ...
These include mass media companies, social service agencies, employers and businesses, labor unions, religious organizations, and other community-based organizations. A list of potential stakeholders in the community envisioned in the model system is presented in Table 61.
|
From page 225... ...
Similar approaches cited in Chapter 4, such as Wisconsin's comprehensive chlamydia prevention program, have been successful. While primarily a screening program, this initiative included public-private partnerships, leadership from legislators, expanded laboratory services, expanded screening in family planning and STD clinics, education of health care professionals, and integrated information systems.
|
From page 226... ...
Increase public awareness and knowledge of STDs and their symptoms and consequences · reduce unbalanced mass media messages · provide health information and access to resources · promote health-care-seeking behavior for symptoms of STDs Reduce prevalence of contributing social factors and other barriers to STD prevention · reduce substance use, sexual abuse, and other contributing factors · address fundamental social problems Reduce prevalence of sexually transmitted infections in population · reduce prevalence in "core" transmission groups · screen and treat high-risk groups · conduct partner notification and follow-up treatment · improve vaccination coverage for STDs (i.e., hepatitis B vaccine) Improve access to health care · provide universal access · develop capacity to deliver care · minimize barrierstocare · promote early health-seeking behavior Improve diagnosis and treatment of STDs · improve diagnostic test characteristics · provide laboratory services · develop new treatments and improve existing treatments · improve training of health professionals Improve effectiveness and access to essential biomedical interventions for STDs · improve effectiveness of barrier methods · develop and implement vaccines and other biomedical interventions Improve the knowledge base · improve surveillance and information systems · improve behavioral and biomedical research Avoid high-risk behavior · seek health information · delay onset of sexual intercourse · reduce number of partners · avoid high-risk sexual practices · avoid high-risk partners · avoid drug and other substance use · use condoms consistently and other barrier methods and microbicides as appropriate Seek medical care promptly for symptoms of STDs Reduce likelihood of infecting partners · assist in partner notification and follow-up · avoid sexual intercourse until cured
|
From page 227... ...
Health Care Professionals and Organizations Physicians, nurses, pharmacists and other health care professionals; managed care organizations and other health plans; hospitals (emergency rooms) ; community health centers; health professional organizations, including medical societies and member organizations Health Programs for High-Risk Populations Juvenile detention health services; jail and prison health services; drug and alcohol treatment programs; migrant health programs; health programs for the homeless Individuals and Families Mass Media Television; radio; print and electronic media; commercial sponsors and advertisers Policymakers Federal, state, and local legislators; government health agency leaders; private health care sector leaders Private Foundations Purchasers of Health Services Private employers; government employee benefits groups; purchasing coalitions; Medicaid and other publicly sponsored programs School-Based Programs K-12 school-based programs; educators; school administrators; school boards; college and university health services STD-Related Programs and Clinics Dedicated public STD clinics; family planning clinics, prenatal clinics, HIV clinics
|
From page 228... ...
To establish a national system for STD prevention, the committee recommends four major strategies for public and private sector policymakers at the local, state, and national levels: 1. Overcome barriers to adoption of healthy sexual behaviors.
|
From page 229... ...
For example, in areas where rates of STDs and risky behaviors are low and access to clinical services for STDs is problematic, improving training of and access to primary care providers and interventions to maintain low rates of risky behaviors may be emphasized. In contrast, in communities where rates of STDs and risky behaviors are high, outreach to health plans, improving public STD clinics, and community-based behavioral interventions may be priorities.
|
From page 230... ...
Therefore, the committee makes the following recommendation: · Improved prevention of STDs should be an essential component of a national strategy for preventing sexually transmitted HIV infection. As part of this effort, federal, state, and local health agencies should review current HIV and STD programs and should coordinate STD and HIV activities related to health education and prevention, clinical services, surveillance, and research and
|
From page 231... ...
HIV/AIDS clinical programs in health plans are encouraged to provide clinical services for other STDs, and HIV prevention programs in health plans also provide interventions for other STDs. Recognizing the Impact of STDs on Cancer Several cancers, including cervical, liver, and other cancers, are associated with sexually transmitted infections that are typically acquired during adolescence or early adulthood.
|
From page 232... ...
STRATEGY 1: PROMOTE HEALTHY SEXUAL BEHAVIORS Strategy 1 is to overcome barriers to adoption of healthy sexual behaviors. Barriers to effective STD prevention efforts include biological, social, and structural factors.
|
From page 233... ...
This is because, as discussed in Chapter 4, in one way or another, all interventions to prevent STDs are partly dependent on, and must be integrated with, healthy behaviors. Despite the progress made in improving awareness of protective behaviors as a result of HIV prevention efforts in recent years, there is still a substantial gap between current practices and the desired social norm of healthy sexual behavior.
|
From page 234... ...
The committee recognizes that the CDC is the primary federal agency with responsibility for STD prevention on a national level, and believes that the CDC should continue to be a leader in federal agency efforts in this area. However, the committee is concerned that the CDC or any other government agency would be unable to fully promote public awareness of healthy sexual behaviors and establish a comprehensive national system of prevention services.
|
From page 235... ...
be funded by a broad range of sponsors, including private foundations, private sector health plans, the biomedical industry, employers, and the Department of Health and Human Services. The Campaign should be funded primarily by a coalition of private foundations with an interest in STDs; these foundations should provide leadership for initiating and maintaining the Campaign and provide "seed" money to establish it.
|
From page 236... ...
Public health agencies and private health care professionals have a responsibility both to educate and to provide accurate public health information to the community, because providing disease prevention information is an essential component of clinical practice. Innovative methods for increasing awareness and reaching the public need to be developed.
|
From page 237... ...
Many adolescents are not receiving appropriate information regarding STDs and healthy sexual behavior from their parents, peers, public health officials, or family doctors to counter misleading mass media messages. Therefore, the committee believes that mass media companies should incorporate messages regarding STDs and healthy sexual behaviors, including delaying sexual intercourse and using condoms, in television and radio programming and the print media, with a special focus on reaching adolescents and young adults.
|
From page 238... ...
Public health officials, including the CDC and state and local health departments, should also function as expert resources for mass media companies in developing and incorporating such messages. · Television, radio, print, music, and other mass media companies should accept advertisements and sponsor public service messages that promote condom use and other means of protecting against STDs and unintended pregnancy, including delaying sexual intercourse.
|
From page 239... ...
All appropriate clinical opportunities to counsel patients regarding healthy sexual behaviors should be utilized. To improve effectiveness of behavioral interventions, clinicians, educators, and researchers need training and skills to deal with issues related to human sexuality and STDs among their patients and students.
|
From page 240... ...
In addition to improving STD prevention efforts, research on sexual behavior has direct benefits in improving prevention programs for HIV and unintended pregnancy. To address the barriers to adoption of healthy sexual behaviors, there needs to be considerably more research regarding the psychological and sociocultural, including religious, factors responsible for the secrecy surrounding sexuality and additional evaluation of approaches (that are respectful of individual beliefs)
|
From page 241... ...
Public and private health agencies, especially those concerned with adolescent, women's, and reproductive health; communicable diseases; cancer prevention; delivery and financing of health services; community health; and public health in general, should strongly advocate for an effective system for STD prevention. National and state health professional societies and organizations and organizations with a special interest in STDs and adolescent, women's, and reproductive health also should work together to ensure that STDs are a priority in both the
|
From page 242... ...
Health Plans and Clinicians. Provide confidential, comprehensive, highquality STD-related clinical services to enrollees/patients and their sex partners; implement clinical practice guidelines for management of STDs; and ensure complete and accurate reporting of surveillance information.
|
From page 243... ...
. Provide confidential, comprehensive, high-quality STD-related clinical services for students and provide instruction regarding STDs and healthy sexual behaviors.
|
From page 244... ...
The Department of Health and Human Services needs to ensure that the agencies within its purview collaboratively provide bold innovative standards, guidance, technical assistance, and resources to state and local health departments and appropriate community-based organizations. Therefore, the committee makes the following recommendation: · Federal government efforts in STD prevention, under the leadership of the Secretary of Health and Human Services, should: 1.
|
From page 245... ...
ensure that health professionals are appropriately and adequately trained to provide STD-related services, including clinical services, disease prevention activities, and community-based prevention programs; 7. ensure that STD prevention activities are an integral part of national HIV and cancer prevention programs; 8.
|
From page 246... ...
provide training and technical assistance to all local jurisdictions to improve the quality and effectiveness of clinical services and prevention programs. Promoting Local Leadership Regarding local government leadership, the committee makes the following recommendation: · Local government efforts in STD prevention, through the leadership of the local health department, with support and technical assistance from the state health department and the CDC, and in collaboration with community representatives, should: 1.
|
From page 247... ...
Effective performance of these roles requires collaborative relationships among local health departments and community-based health services, private sector health care professionals, health plans, laboratories, and others in the community. STD services and programs in most local health departments currently are relatively isolated from other providers in the community.
|
From page 248... ...
Leadership is needed to establish and maintain a Roundtable on STD prevention. At the current time, there is a lack of leadership among private health care sector organizations in this area.
|
From page 249... ...
recruit and involve public agencies and private organizations, including health plans, employers and other purchasers of health services, health professional organizations, pharmaceutical and medical device companies, and other providers of STD-related services; 6. seek input from, provide guidance to, actively involve, and communicate with providers of STD-related services on local and state levels; and 7.
|
From page 250... ...
Unfortunately, there is surprisingly little data either on absolute expenditures for STD prevention or the cost-effectiveness of different types of expenditures. Thus, the committee recommends that rigorous analyses of the cost-effectiveness of different types of prevention programs be conducted.
|
From page 251... ...
, public STD clinics, family planning clinics, community health centers, and other publicly sponsored health care programs. Businesses pay for STD-related costs through higher health insurance premiums for their workers and lost productivity of employees with STDs.
|
From page 252... ...
Therefore, in both cases, the entire community directly benefits from preventing STDs and should assume financial responsibility for STD prevention. Specific potential mechanisms for ensuring funding for STD-related services may include allowing public STD clinics to be contract providers for health plans, requiring health plans to reimburse STD and other public health clinics for out-of-plan use of services, and imposing an assessment on health plans for services and programs that benefit the broad community.
|
From page 253... ...
Local health departments, in particular, will require additional funding and technical assistance from the CDC and the state health department to fully assume the responsibilities of ensuring access to STDrelated services. If federal staff assistance to states and localities is reduced, resources should be redirected back into state and local STD programs to ensure that the state and local infrastructure can be incrementally shifted from reliance on federal direct assistance to a state and locally directed program.
|
From page 254... ...
In addition, state and local health agencies may end up with less money than they currently have for STDs, unless state and local governments increase funding. Many elected state officials favor block grants because it gives them more discretion over resource allocation.
|
From page 255... ...
develop performance objectives in collaboration with local communities and health departments; 3. meet minimum national quality standards for STD-related services (see recommendations for improving the quality of dedicated public STD clinics for more details)
|
From page 256... ...
Strengthening Global STD Prevention Efforts STDs are emerging infections and a global public health problem. As discussed in Chapter 2, new STDs with a potentially devastating impact are likely to emerge and become established in the United States.
|
From page 257... ...
With technical assistance from the CDC and state health departments, they will need to develop effective reporting systems and actively work with community-based and private health care professionals to ensure accurate and complete reporting. Their responsibilities should include feedback regarding local STD trends to health care professionals to inform and engage them in STD prevention efforts.
|
From page 258... ...
Specific areas for improvement include the following: 1. The CDC and the states should improve reporting from private sector health care professionals and laboratories and collect data on the number of persons tested for STDs through the national surveillance system.
|
From page 259... ...
The ability of public STD clinics and health departments to effectively monitor arrangements or contracts with private health plans will be contingent upon the capacity of STD-related information systems to generate relevant and timely information on program performance measures. Existing data systems of STD programs are not
|
From page 260... ...
, managed care organizations and other health plans, and other health care professionals to develop and utilize information systems that effectively integrate preventive services performance data with community health status indicators and STD program data. STDrelated information systems should support assessment and evaluation of antici
|
From page 261... ...
and other health services performance measures to improve quality-assurance monitoring of STDs. The National Committee for Quality Assurance and other relevant organizations, in conjunction with public health agencies and health plans, should continue to develop and promote performance measures related to STD prevention.
|
From page 262... ...
Expanding Prevention-Related Research New research may be used to develop effective prevention programs, but such programs need to be modified regularly based on continuous evaluation of existing programs and changes in the epidemiology of STDs and the health care environment. Prevention-related research allows program managers to maximize the effectiveness of interventions and policymakers to maximize available resources.
|
From page 263... ...
The committee agrees with the above assessments and recommends that general areas of additional research in STD prevention include behavioral, biomedical, and operational research. In addition, the committee recommends that the following specific topics be studied: determinants of sexual behavior and sustained behavior change on an individual and community level; determinants of initiation of sexual intercourse among adolescents; influence of social and other community-related factors on risk of STDs; interventions to improve condom use and reduce high-risk behaviors; effectiveness of sexual risk behavior assessment and counseling; biomedical interventions that do not rely primarily on individual behavior, such as vaccines; female-controlled prevention methods; cost-effectiveness of preventive interventions, including partner notification and treatment techniques; methods for preventing STDs among disenfranchised populations; interventions for preventing STDs among persons of all sexual orientations; and methods to measure prevention program effectiveness.
|
From page 264... ...
Therefore, STD prevention programs need to focus on adolescents. The committee's proposed focus and recommendations regarding appropriate policies to prevent STDs among adolescents are similar to those of numerous health professional and other organizations (AMA, 1996)
|
From page 265... ...
and mass media campaigns should comprise two major components of an effective prevention strategy for adolescents. Although school-based prevention programs should be a major means for preventing risky sexual behaviors among adolescents, it is not realistic to expect that such programs will be successful in all situations or that they will be effective in isolation.
|
From page 266... ...
Interventions should focus on preventing the establishment of high-risk sexual behaviors. · All health plans and health care providers should implement policies in compliance with state laws to ensure confidentiality of STD- and familyplanning-related services provided to adolescents and other individuals.
|
From page 267... ...
the National Committee for Quality Assurance and other organizations that accredit health plans should ensure that a health plan's ability to ensure confidential access to STD-related services is appropriately assessed; 3. state and local health professional organizations should disseminate information regarding the importance of maintaining patient confidentiality to their members; and 4.
|
From page 268... ...
Besides providing information, school-based education programs need to provide students with the skills to implement healthy sexual behaviors. The committee believes that it is possible to increase knowledge, change attitudes, and influence behavior of adolescents by expanding the use of schoolbased health education curricula and by providing the training and support necessary to improve existing programs.
|
From page 269... ...
Local health departments, health plans, and other private sector organizations should form partnerships with schools to establish and maintain these and other STD prevention programs; and 3. ensure that school-based and school-linked health clinics provide STDrelated clinical services, such as counseling for high-risk sexual behaviors; screening, diagnosis, and treatment of STDs; and hepatitis B immunization for all students.
|
From page 270... ...
Given the difficulty in reaching adolescents in health care settings, public health officials should ensure that adolescents who are not immunized in health care settings are immunized through school-based or other community programs. Additional infrastructure and programs for vaccinating adolescents and adults at risk for hepatitis B virus infection, through settings such as public STD clinics, should be developed and implemented.
|
From page 271... ...
In order to appropriately address target behavioral risk factors, however, surveillance of sexual behaviors and STDs is essential. Most of the research regarding drugs, alcohol, and STD transmission cited in Chapter 3 is cross-sectional in nature and does not allow for determination of cause and effect.
|
From page 272... ...
Despite the barriers that make delivery of services in these settings challenging, it is critical that STD-related services be provided in places where persons at high risk for STDs are frequently encountered. Such services may either be furnished by staff of these facilities or supplied through partnerships with local health departments, health plans, and other organizations.
|
From page 273... ...
Given the variety of agencies that provide services to substance users, the Department of Health and Human Services, including the CDC and the Substance Abuse and Mental Health Services Administration, should work with other federal agencies to coordinate STD prevention programs for substance users. Providing STD-related services to disenfranchised persons requires innovative approaches, additional planning, and resource commitments because of the special considerations and staff skills that are needed to reach these populations.
|
From page 274... ...
In addition, such companies should ensure that the cost of existing and new biomedical interventions for STDs are affordable to publicly sponsored STD programs. STRATEGY 4: ENSURE ACCESS TO SERVICES Strategy 4 is to ensure access to and quality of essential clinical services for STDs.
|
From page 275... ...
ensuring access to services at the local level, (b) improving dedicated public STD clinics, (c)
|
From page 276... ...
With very few exceptions, it appears that private health care professionals are unaware of both the prevalence of STDs among privately insured persons and the serious and expensive sequelae of undetected infections. Therefore, the committee makes the following recommendation: · Comprehensive STD-related services should be incorporated into primary care, including reproductive health services.
|
From page 277... ...
Public health agencies may consider one or a combination of alternative models for providing services, including provision of services through contracts or agreements with public sector health programs, community-based health programs, universities or teaching hospitals, or private health care professionals, including managed care organizations and other health plans. Contracts and partnerships may include agreements regarding patient referral for specific services, sharing of resources, or shared administration and management of programs.
|
From page 278... ...
Although many small communities and communities with low STD rates do not require dedicated public STD clinics, nearly all states in the United States have one or more cities with such clinics. Again, local health officials need to assess the status of clinical services in their communities and determine the most appropriate model for delivering services.
|
From page 279... ...
Based upon local conditions and health department determination, dedicated public STD clinics should continue to function as a "safety net" provider of STD-related services for uninsured and disenfranchised persons and for those who prefer to obtain care from such clinics. Should universal health care coverage in the United States be achieved, or if proposed changes in the existing delivery system for STD-related clinical services, including incorporating STD-related clinical services into primary care and improved access to
|
From page 280... ...
Nevertheless, these partnerships have steadily increased and, in nearly every instance, have resulted in improved patient care and training for health care professionals and have increased the number of high-quality public STD programs. Such collabora
|
From page 281... ...
Compared with other health plans, the structure and resources of many managed care organizations allow for improved coordination and integration of care, accountability of services, incentives to provide preventive services, and quality monitoring of services through information systems. Managed care organizations have the potential to provide higher quality, more comprehensive STD-related services than traditional indemnity health insurance plans and independent private practice clinicians, who may have little incentive to provide preventive services.
|
From page 282... ...
. Given the limited data available regarding the scope and quality of STDrelated services provided within the range of private sector health care settings, the CDC, in collaboration with the American Association of Health Plans, the National Committee for Quality Assurance, and the Health Insurance Association of America, should jointly sponsor or conduct a study to examine such services provided in private sector settings, including managed care organizations and other health plans.
|
From page 283... ...
Plans that have a small market share or operate in a volatile market may be unlikely to invest significantly in disease prevention because of the high turnover rate of enrollees. Finally, many health plans have not supported STD prevention activities because they have traditionally relied on the availability of services in public STD clinics and, as a result, have not developed the capacity to deliver comprehensive STD-related care.
|
From page 284... ...
Involving Employers and Other Purchasers of Health Care Employers, government agencies, and other purchasers of health care services have a potentially powerful influence on the scope and quality of STDrelated services provided by health plans. Purchasers are the key to ensuring that managed care organizations and other health plans provide comprehensive, high
|
From page 285... ...
Pressures on local health agencies, such as reduced funding for STDrelated services and the enrollment of Medicaid beneficiaries into managed care health plans, are resulting in the shifting of services within the public sector and between the public and private sectors. Some agencies have begun to provide STD-related clinical services along with more comprehensive primary care services, and many are seeking ways to shift STD-related services to the private sector.
|
From page 286... ...
Effective performance of these roles requires improved collaboration among local health departments and community-based health services, private sector health care professionals, health plans, and other community stakeholders. The recent trend toward managed care in many states is increasing the proportion of Medicaid beneficiaries who will have to obtain their health care from managed care organizations.
|
From page 287... ...
This problem is made worse because health plans require enrollee permission for a provider to bill for services, thus threatening the very confidentiality sought by the enrollee. Therefore, the committee makes the following recommendation: · Health plans, including managed care organizations, should develop collaborative agreements with local public health agencies to coordinate STD-related services, including payment for STD-related services provided to plan enrollees by public sector providers, including public STD clinics.
|
From page 288... ...
The current system of clinical training for health care professionals, as outlined in Chapter 5, is inadequate in preparing clinicians to effectively manage patients with STDs. Studies examined by the committee suggest that many health care practitioners in both public or private settings are not sufficiently prepared to provide STD-related clinical services.
|
From page 289... ...
In areas with university-affiliated public STD clinics, it is most efficient for primary care clinicians to develop expertise in STD case management given the high volume and range of STDs seen in these facilities. Thus, courses specifically designed for primary care providers should present the management of STDs within a primary care context, where patient care issues and other clinical resources are different from those of dedicated STD clinics.
|
From page 290... ...
training based on a core set of clinical competencies, including population-based health promotion and disease prevention techniques, evidence-based clinical decision-making skills, and patient communication skills. The training experience should include experience in both dedicated STD clinics and primary care settings and instruction regarding techniques to promote individual behavior change and improve disease reporting; 2.
|
From page 291... ...
Preventive Services Task Force has identified effective clinical preventive services for STDs, and several agencies and health professional organizations have published similar recommendations. These guidelines are important in establishing preventive services for STDs as standard clinical practice for all clinicians.
|
From page 292... ...
The CDC, the Agency for Health Care Policy and Research, the National Institutes of Health, and other federal agencies should collaborate with health professional organizations and representatives of health plans to develop comprehensive, consensus clinical practice guidelines for primary care clinicians for STD-related services including screening, risk assessment, and counseling and other clinical interventions to promote healthy sexual behaviors. These guidelines should build on the work of the U.S.
|
From page 293... ...
Such therapy should be reimbursed by Medicaid programs and private health insurance plans. Although the pharmaceutical industry has been willing to provide single-dose therapies to public STD clinics at reduced contract prices, some public STD clinics and other public programs still lack sufficient funds to offer single-dose therapy in all situations where it is clinically indicated.
|
From page 294... ...
Counseling for STDs, including HIV infection, should be reimbursed without copayments or other financial disincentives by Medicaid programs, managed care organizations, and other health plans. The recommendations of the U.S.
|
From page 295... ...
The optimal combination of activities that are most effective at reaching persons at risk for STDs will vary depending on the local epidemiology of STDs, available resources, and the spectrum of local public and private health care professionals treating STDs. STD programs need to develop new strategies and techniques for community outreach in partnership with other health care professionals rather than relying solely on health department or public STD clinic staff.
|
From page 296... ...
The concept that partner treatment is part of standard STD clinical management should be reinforced among private sector clinicians as well as among health plans. The committee believes that health care professionals and health plans have an ethical and public health obligation to ensure that the sexual contacts of their patients with STDs are notified promptly of potential exposures, counseled regarding risk factors for infection, and offered diagnostic testing and treatment.
|
From page 297... ...
Such laboratories should develop mechanisms to bill health plans for laboratory services. State and local health departments should negotiate adequate reimbursement for such services from health plans.
|
From page 298... ...
Collaborating with Other Public Sector Health Programs As in the case of community-based and private sector clinics, local health departments that provide STD-related clinical services should ensure that such services are provided in primary care settings, including reproductive health programs. The DeKalb County health department in Georgia, for example, has integrated STD and HIV screening and counseling services and is beginning to provide both services in family planning and primary care clinics.
|
From page 299... ...
Most important, services are centered on the patient, coordinated by a primary care provider, documented in a single medical record, and monitored by relevant public health agencies. In addition, local health departments in several cities (e.g., Baltimore, Boston, Denver, Minneapolis, and Portland)
|
From page 300... ...
In addition, the demonstration projects cosponsored by the CDC and the Office of Population Affairs are increasing collaboration among dedicated public STD clinics, family planning clinics, and public laboratories. The committee believes that these types of collaborative approaches should be expanded to all STDs.
|
From page 301... ...
. Blueprint for a healthy community: a guide for local health departments.
|
From page 302... ...
Zimmerman DJ, Reif CJ. School-based health centers and managed care health plans: partners in primary care.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.