Coded Text Messaging to STD Clients

State: IL Type: Model Practice Year: 2010

This practice addresses access to care within a typically difficult population to reach for treatment and follow-up of diagnosed STDs. Accessing treatment is a crucial health determinant for the control of STDs. Utilizing test messaging, a standard form of communication among adolescents and young adults, increases access to treatment and partner notification. The primary goal of this project was to decrease the length of time from diagnosis of an STD to treatment and to improve partner notification. STD rates in Peoria County have long exceeded those for the state of Illinois despite many efforts to decrease these rates. The call-back method of obtaining results and returning for treatment of diagnosed STDs at the Peoria City/County Health Department STD Clinic took clients an average of 14 days, thus increasing the risk of transmission between partners. Clearly this method for the target population and traditional field investigation work was not effective. Text messaging among the target population is a well accepted communication practice and the majority of clients accessing STD services preferred text messaging to phone calls which was confirmed by an informal survey of clients. By utilizing an alternate method of communicating results and need for treatment clinic staff believed that the time between diagnosis and treatment could be significantly reduced, increasing access to care and follow-up. Compared with the traditional method of call-back, clients receiving results by text message were treated within one day of receiving the message, while those calling for results averaged three days between diagnosis and treatment. Clients needing to return for treatment and choosing to receive a text message averaged 0.74 days to receive treatment. Clients who chose to call the clinic and needed to return averaged 2.42 days to receive treatment. Due to the consistent high rate of STD incidence in Peoria County the clinic proactively treats symptomatic males at the time of testing. Among those clients proactively treated and who opted for text message, 40% of them called the clinic to confirm their result compared to 15% of clients who chose to call the clinic, providing an additional opportunity to review discharge instructions and partner notification. A timeliness treatment comparison for females testing positive for an STD showed improvement. In FY 2008, 76% of the females were treated for gonorrhea within 14 days and 74% were treated for Chlamydia within 14 days. For FY 2009, 87% of the females were treated for gonorrhea within 14 days and 81% were treated for Chlamydia within 14 days. Decreasing length of time between diagnosis and treatment cannot be solely related to text messaging, however text messaging has positive implications.
The practice addresses one strategy focusing on the high rates of reported sexually transmitted diseases in Peoria County. For more than 10 years Peoria County has ranked in the top five counties in Illinois for reported gonorrhea and Chlamydia cases. The majority of reported cases of gonorrhea and Chlamydia are diagnosed among persons age 15 to 24 years of age (75%). A review of risk assessments collected from the STD clinic for clients 15-24 years of age revealed greater than 50% have had five or more sex partners within a 12 month period and it took an average of 14 days for clients in this age group to receive treatment after diagnosis.The relevancy was essentially determined by review of STD epidemiological data, the risk of known health complications that occur with exposure to STDs and barriers to services in our community. Significant barriers to accessing adolescents within the public school systems and school-based health centers exist. STD’s among this population are predominately diagnosed and treated in the Health Department STD clinic. One in four adolescents are diagnosed with an STD within Peoria County. In the Health Department MCH program, 36% of pregnant mothers were infected with an STD two or more times in 2007. The practice addresses the issue by using a technology that our target population has access to and prompts them into treatment faster than relying only on the client to call for test results. The decreased length of time between diagnosis and treatment can reduce the risk of developing complications associated with STD infections and reduce transmission rates. The STD clinic implemented Internet Risk Reduction Counseling in 2005, providing experience using technology as a effective tool for STD prevention. In addition, clinic staff have attended State and National Conferences where sessions were hosted related to text messaging as an effective method to reach clients. This practice differs from other approaches by addressing behavior changes associated with accountability related to receipt of treatment. Clients who opted to receive a text message clearly are more accountable by returning the same day (95%) for treatment compared to clients who chose to call the clinic came in the same day for treatment (61%). Among proactively treated clients, 40% of those who opted to receive a text message confirmed their results compared to 15% of those who chose to call for their test results. Notifying clients of their STD results by using a text message is more efficient and reduces potential exposure to untreated STDs among a population who often has multiple partners. Utilizing technology that is widely accepted and used by the target population has increased personal responsibility for follow-up. Notifying clients of their STD results by using a text message is more efficient and reduces potential exposure to untreated STDs among a population who often has multiple partners. Utilizing technology that is widely accepted and used by the target population has increased personal responsibility for follow-up. Beginning spring of 2010, the STD clinic staff will be meeting with selected private practices to provide guidance on text messaging strategies for implementation. Currently the Health Department works closely with providers in the community to foster positive relationships in an effort to sustain timely reporting, proper treatment and follow-up for all diagnosed STD's. Numersous projects completed by undergraduate and graduate students have identified the issues related to high STD rates in the community. Results have been shared with key stakeholders to engage those working with adolescents and young adults for a community-wide approach to decreasing these rates. Positive response has been recieved and strong support has been provided by the Board of Health to implement strategies to decrease treatment times and decrease overall rates. A task force was developed in 2008 and continues to meet regul
Agency Community RolesThe core group of persons seeking testing and treatment at the Peoria City/County Health Department is adolescents and young adults. In FY 2009, the STD clinic positivity rate for gonorrhea and Chlamydia was approximately 17%, 10 to 15 percent greater than all other reporting agencies in Peoria County. Aside from testing and treatment, the Health Department ensures adequate treatment for STDs is provided at local private health care clinics and the STD clinic staff will conduct field investigative work on clients from private clinics that need treatment. The LHD role in this practice is to identify a strategy that addresses these high rates of STDs and to share with our community partners an effective tool to address timely treatment for STDs. The primary stakeholders in the planning and implementation processes were the staff in the STD clinic. It is the staff responsibility to test and treat, and conduct field investigation work therefore, it was essential they were involved in the planning and development of the practice. Costs and ExpendituresAn Email account was set up with IT services on the Health Department Microsoft Outlook program. IT services also provided a list of all cell phone company text Email addresses. The STD clinic staff developed a coded message to protect confidentiality. (Code 1 meant that gonorrhea and Chlamydia test were negative; Code 2 meant that the client needed to contact his/her nurse. When the client calls with a Code 2 they are notified of a positive STD test and a time to return for treatment is scheduled. Clients seen in the clinic were provided with an instruction sheet on how they will receive a coded text message if this method is preferred to calling back for results. There were no start-up cost and minimal amount of staff time was spent to implement the program. Local tax dollars and minimal client fees support the STD clinic. No other funds were pursued or obtained for this project. ImplementationIn order to achieve the identified objectives of the practice, the Peoria City/County Health Department needed to take an informed risk to improve access to service for an at-risk population. Funds were not available to invest in travel, training, or consultants. Therefore, implementation had to come from existing technology and observation of the STD clientele. This was completed over a three month period. As the strategy was implemented only five months ago in the STD clinic and two months ago in MCH/WIC programs, data is limited but promising. Data collection will continue with changes made to respond to identified target population needs and preferences. Data will be shared with private practices in an effort to implement the strategy community-wide. Preliminary observations and data collection occurred within a year of implementation.
To improve access to service to a high risk population. To decrease the length of time from diagnosis to treatment in diagnosed STD's. The performance measure was to have clients 15 to 24 years of age seen in the STD clinic opting to receive their STD results by text message.For clients who tested positive for either gonorrhea and/or Chlamydia data was collected on: age, race, gender, if treatment was needed, and length of time it took the client to return for treatment. The clinic staff provided the Supervisor with the data and it was entered into an excel file.Data was collected from Dec. 1, 2008 through May 30, 2009 and Sept. 1, 2009 through Dec. 30, 2009. Staff kept a log to record the data and submitted to the Supervisor once a week.The data was reviewed with the STD staff. Some clients who opted for the text message claimed they did not receive the text. The number of clients who reported no text message was received is less than ten. It was agreed by staff to reinforce to clients if they do not receive their text message that they call the clinic for their results. Clients who did not receive their text message was unintended. The most probable cause is human error related to data entry of the client contact information. Preliminary data indicates that those individuals choosing text messaging for STD results receive treatment twice as fast as those who do not. Implementation of a cost effective and efficient system to decrease STD incidence in the adolescent population. The overall cost of treatment and follow-up for clients diagnosed with an STD will be significantly reduced utilizing this strategy. Cost comparison of traditional method of follow-up and the text messaging strategy Staff time and cost for field visits and traditional strategies were identified and compared with time and cost for text messaging. The average Public Health Nurse salary is $24.34/hour and it is estimated the follow-up investigation work took one hour per client. The labor cost is estimated at $48.68 to get clients to return for treatment.The estimated overall cost is $438.12. Traditional field work is estimated to take three to four hours, thus increasing cost accordingly. Implementation of a strategy appealing to the target population. At least 65% of those seeking diagnosis and treatment at the STD clinic will opt for text messaging as a way to receive results. Data was collected on gender, race and age and documenting how each client chose to recieve results. The STD clinic maintains a log for STD screening for each clinic day. The log records, gender, race, age, date tested, STD diagnosis and if treatment is needed. Staff would record on the log if the client called for their result and submitted to the Supervisor once a week. Clients that opted to receive their tests results by text message would voice their approval. The most common comment was the convenience to receive a text message. The STD clinic client is predominately male (60%). For text message, 54% were African American male, 17% Caucasian male, 14% African American female and 17% Caucasian female. For those who would call the clinic, 60% were African American male, 8% Caucasian male, 26% African American female, and 6% Caucasian female. The objective was met with the male clients, however females more often opted to contact the clinic rather than receive a text message.
The practice of text messaging STD results has been favorably received by clients and by the Board of Health. Due to decreased cost and decreased time in obtaining treatment, this practice will continue with expansion to community providers. Continued data collection will further develop and enhance the project. The initial implementation of the text message practice was at no additional cost or related to a grant for the Health Department and preliminary cost comparisons indicate an actual cost savings not only for the strategy itself but for decreasing the cost burden of STD transmission and complications related to untreated STD’s. Additional time will be spent providing community practices with guidance to implement the strategy with emphasis on a community-wide approach in reduction of STD transmission.