Title: Research and Policy Development in a County Department of Public Health
1Research and Policy Development in a County
Department of Public Health
- Mitchell H. Katz, MD
- Director of Health
- Mitch.Katz_at_sfdph.org
2Advantages of Conducting Research ina Department
of Public Health
- Access to surveillance databases
- AIDS
- Sexually transmitted diseases
- Tuberculosis
- Other reportable diseases
3Advantages of surveillance databases
- Population-based
- Longitudinal outcomes
- Large sample sizes
- No cost for data collection
- Available for choosing cases and controls
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7Advantages of Conducting Research in a Department
of Public Health
- Close relationships with community-based
organization - Aware of emerging issues
8Tracing a Syphilis Outbreak through Cyberspace
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10Tracing a syphilis outbreak through cyberspace.
OR 8.7 P .03
11Advantages of Conducting Research in a Department
of Public Health
- Public Health Lab
- Stored specimens
12Incidence of HIV Among Men Having Sex With Men
(MSM) San Francisco, 1994-1999
13Advantages of Conducting Research ina Department
of Public Health
- Special funding relationships with the CDC, HRSA,
and the State of California
14Advantages of Conducting Research ina Department
of Public Health
15Problem High re-infection rate among clients at
STD Clinic
- Difficulty getting clients to bring in their
partners for treatment. - California Medical Practices Act forbids
prescription of antibiotics by a physician
without examining the patient. - California Heath and Safety Code authorizes
county local health officer to take all necessary
measures to prevent the transmission of
infectious diseases.
16Solution Change policy to allow clinicians to
bring home treatment to their partner (1998).
- Study Impact. Telephone survey of STD clients who
received partner packets (N54). - 73 of partners took treatment.
- 57 of couples discussed STDs.
17Develop support for a broader change
- San Francisco Medical Society votes to support
partner treatment. - California Medical Association votes to support
partner treatment.
18Improve the world
- SB -648 (2001)
- Authorizes physicians and mid-level practitioners
to prescribe partner antibiotic therapy for
Chlamydia. - AB-2280 (2006)
- Authorizes patient delivered therapy to partners
of individuals diagnosed with gonorrhea or other
sexually transmitted diseases.
19Randomized-controlled trial of expedited therapy
versus standard practice(Golden MR NEJM 2005
352 676)
- Expedited therapy patient delivered or clinician
delivered without a physical examination outcome
persistent or recurrent gonorrhea or chylamydial
infection standard. - Standard therapy patients told to bring their
partners in. - Outcome persistent or recurrent gonorrhea or
chylamydial infection.
20Problem Twenty years after licensing of HIV
test estimated 252,000 to 312,000 in US are
unaware that they are infected.
- Numerous barriers to testing.
- Change those you can.
21Solution Eliminate written consent for HIV
testing in San Francisco delivery system
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23Develop Support for a Broader Change
- Work with HIV activists.
- Improve the world
- AB 682 - - changed the standard for testing by
medical providers to right to decline. Passed by
legislature and signed by governor.
24Use Research Results to GuidePolicy Development
- Finding Uninsured persons have less access to
care, present later in the course of illness, and
have worse outcomes for a number of different
diseases. - Solution Healthy San Francisco a coverage
initiative for providing comprehensive coverage
for health services to the uninsured regardless
of income, immigration status, or pre-existing
conditions.
25Problem Uninsured persons have poorer access to
health services
- Finding Tobacco is the number 1 cause of
preventable death in San Francisco and in the US
as a whole. - One Solution San Francisco becomes the first
locality to ban pharmacies from selling tobacco
to avoid sending a mixed message to nonsmokers
and those trying to quit.
26Disadvantages of Research in aDepartment of
Public Health
- Environment not generally geared to research
- Need to triumph over Good enough for
government work - Can be difficult to carve out time from competing
priorities