|
|
|
Partner Management: A Step-by-Step Approach for Clinicians
- Review diagnosis and risk of transmission to partner(s).
- Calculate the correct time periods for which partner(s) should be elicited (differs by disease). In this case, the recommended time period would be to go back 60 days from diagnosis/treatment to elicit partners.
- Encourage patient to enumerate all partner(s) within the critical time period.
- Assess partner type (e.g., steady/long-term/ "main" partner, "one-night stand", and anonymous partner).
- Assess type of exposure by partner (oral, genital, and/or anal).
- Review benefits to patient (e.g., avoiding risk of re-infection and the ability to resume sexual relations with ongoing partner(s)).
- Review risks to untreated partner(s) (e.g., long-term complications and increased HIV susceptibility).
- Review benefit to peers/community (e.g., limit ongoing transmission and decrease burden of disease in community).
- Assess patient fears.
- Assess potential impact upon long-term relationship.
- Assess risk of violence and harm to patient in response to discussion with partner.
- Denial: discuss the possibility of asymptomatic transmission and /or persistent asymptomatic infection (i.e. possibility from previous partner).
- Claim of a recent "check-up": discuss the need for presumptive treatment, limitations of some screening tests, and false assumption that a "check-up" always includes specific STD testing such as testing for gonorrhea.
- Blame, anger, and violence: counsel or refer patient if there is a history of continuing or future violence.
Many providers rely upon local health department resources for partner elicitation and follow-up. Treating providers should explain to patients treated for syphilis that they most likely will be contacted by local health department staff in order to confirm treatment and attempt to facilitate partner management.
- Establish a specific plan for partner referral with agreed upon timeframes
- Come to an agreement with patient regarding specific approach to notifying partners
Provider/Health Department Referral: Occurs with the consent of the infected person. Trained health department personnel locate and notify partners of their risk (names, descriptions, and addresses are voluntarily provided by the patient), and refer to appropriate services. Ensures patient confidentiality, as names, and identifying or locating information of the original patient are not revealed to partners who are notified.
Patient (self) Referral: The patient (self) referral method is a process whereby patients agree to inform their partners of their possible exposure and refer to appropriate services.
- If patient (self) referral is used, coach the patient on effective ways to approach telling his/her partner(s) of their possible exposure and provide referrals to appropriate services (e.g., provide a telephone number for the partner to call and schedule a clinic visit).
|
|
|
|
|
| |
