Research and Policy Development in a County Department of Public Health - PowerPoint PPT Presentation

1 / 26
About This Presentation
Title:

Research and Policy Development in a County Department of Public Health

Description:

Incidence of HIV Among Men Having Sex With Men (MSM): San Francisco, 1994-1999 ... mid-level practitioners to prescribe partner antibiotic therapy for Chlamydia. ... – PowerPoint PPT presentation

Number of Views:36
Avg rating:3.0/5.0
Slides: 27
Provided by: TYS6
Category:

less

Transcript and Presenter's Notes

Title: Research and Policy Development in a County Department of Public Health


1
Research and Policy Development in a County
Department of Public Health
  • Mitchell H. Katz, MD
  • Director of Health
  • Mitch.Katz_at_sfdph.org

2
Advantages of Conducting Research ina Department
of Public Health
  • Access to surveillance databases
  • AIDS
  • Sexually transmitted diseases
  • Tuberculosis
  • Other reportable diseases

3
Advantages of surveillance databases
  • Population-based
  • Longitudinal outcomes
  • Large sample sizes
  • No cost for data collection
  • Available for choosing cases and controls

4
(No Transcript)
5
(No Transcript)
6
(No Transcript)
7
Advantages of Conducting Research in a Department
of Public Health
  • Close relationships with community-based
    organization
  • Aware of emerging issues

8
Tracing a Syphilis Outbreak through Cyberspace
9
(No Transcript)
10
Tracing a syphilis outbreak through cyberspace.
OR 8.7 P .03
11
Advantages of Conducting Research in a Department
of Public Health
  • Public Health Lab
  • Stored specimens

12
Incidence of HIV Among Men Having Sex With Men
(MSM) San Francisco, 1994-1999
13
Advantages of Conducting Research ina Department
of Public Health
  • Special funding relationships with the CDC, HRSA,
    and the State of California

14
Advantages of Conducting Research ina Department
of Public Health
  • Analysis drives policy

15
Problem 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.

16
Solution 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.

17
Develop support for a broader change
  • San Francisco Medical Society votes to support
    partner treatment.
  • California Medical Association votes to support
    partner treatment.

18
Improve 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.

19
Randomized-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.

20
Problem 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.

21
Solution Eliminate written consent for HIV
testing in San Francisco delivery system
22
(No Transcript)
23
Develop 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.

24
Use 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.

25
Problem 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.

26
Disadvantages 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
Write a Comment
User Comments (0)
About PowerShow.com