Program Details

Practice Type:	Model
Program Name:	The Spokane County STD Medical Coalition: Investing in Community Collaboration for the Purpose of Disease Control
Organization:	Spokane Regional Health District
Web site:	http://
Overview:	The Spokane County STD Medical Coalition: Investing in Community Collaboration for the Purpose of Disease Control
Year Submitted:	2011
Responsiveness and Innovation:	Chlamydia trachomatis is the most frequently reported communicable disease in Spokane County. Nationwide, the highest rates of chlamydia occur in young women less than age 19 years, the next highest in young women age less than 25 years. In Spokane in 2009, the highest reported incidence is in young people ages 20-24 (1499.3/100,000). Adolescents ages 15-19 have the second highest rates of chlamydia (1238.6/100,000). The reason for the discrepancy between local and national data is not know for sure. However, access to care may be a factor, and actual incidence may be greater than the data demonstrates due to insufficient testing among minors. Adolescents are generally at higher risk of acquiring an infection due to the greater likelihood of unsafe sexual practices, such as multiple partners and unprotected sex. National Youth Risk Behavior Survey (YRBS) data indicate that almost 50% of adolescents have had sex by age of 18. In addition, adolescent females are more susceptible than older women to infection because of developmental differences in the cell structure of the cervix. Research indicates that one in four sexually active youth are infected with an STD by age 24. Most chlamydia infections are asymptomatic and there are serious potential health consequences to undiagnosed infection. The clinical sequelae of chlamydia infection includes chronic pelvic pain, pelvic inflammatory disease (PID), ectopic pregnancy, spontaneous abortion, neonatal conjunctivitis and pneumonia, preterm labor and low birth weight, and infertility. Untreated infections often result in long-term consequences to sexual and reproductive health and subsequently contribute to rising health care costs. It is estimated that untreated chlamydia infection and associated sequelae costs the United States more than $2 billion per year. The burden of disease on patients, health care payers, and society is substantial and unnecessary. Addressing rising rates of chlamydia and other STDs and improving the general reproductive health of Spokane County residents by addressing risky sexual behaviors, particularly among adolescents and young adults, became a strategic priority of the SRHD’s Disease Prevention and Response Division.
Agency and Community Roles:	The role of the Spokane Regional Health District (SRHD) is to serve as primary facilitator of the Coalition. The Coalition is facilitated by a SRHD representative and a clinician representative from the medical community. From its inception, the STDMC has been a collaboration to address a public health issue—the burden of STDs in the community. As the primary facilitator, the SRHD convenes meetings, identifies promising practices to consider for implementation, gauges interest from the STDMC, and works with the group to formulate action plans for implementation of chosen practices and projects.
Costs and Expenditures:	The Spokane County STD Medical Coalition (STDMC) is a coalition of local health care providers and other partners formed in January 2007 in response to increasing rates of chlamydia and other sexually transmitted diseases (STDs). The Spokane Regional Health District (SRHD) surveyed all Spokane County physicians, physician assistants (PAs), and nurse practitioners (ARNPs) practicing in the five specialties that provide the majority of STD-related care in November of 2005. The purpose of the survey was to evaluate the extent to which providers in Spokane County were screening patients for chlamydia, to identify potential barriers to screening, and to identify strategies for public health intervention. Almost 40% of providers were found to not be screening according to recommended clinical practice guidelines. Survey results were used to identify strategies to improve chlamydia screening rates of Spokane County clinicians; a primary recommendation was to use a peer-to-peer approach to influence the practice of other clinicians in the community. Survey respondents had also been asked to indicate whether or not they would be willing to serve on a local STD expert panel. The response to this question was positive; 48 providers indicated that they would, or potentially would serve in such a capacity. Providers who had indicated interest in participating on an expert panel were invited to an initial meeting in January 2007—thus forming the current STD Medical Coalition. The goal of the STD Medical Coalition is to improve reproductive health and reduce sexually transmitted diseases in Spokane County through the following objectives: 1) improving STD-related care in the community by influencing the practice of clinicians, 2) promoting sexual and reproductive health policy to influence clinicians, schools, and billing systems, and 3) providing guidance to SRHD on various public health projects and community outreach efforts to increase uptake of preventive screenings and prevention knowledge.
Implementation:	Chlamydia trachomatis is the most frequently reported communicable disease in Spokane County. Nationwide, the highest rates of chlamydia occur in young women less than age 19 years, the next highest in young women age less than 25 years. In Spokane in 2009, the highest reported incidence is in young people ages 20-24 (1499.3/100,000). Adolescents ages 15-19 have the second highest rates of chlamydia (1238.6/100,000). The reason for the discrepancy between local and national data is not know for sure. However, access to care may be a factor, and actual incidence may be greater than the data demonstrates due to insufficient testing among minors. Adolescents are generally at higher risk of acquiring an infection due to the greater likelihood of unsafe sexual practices, such as multiple partners and unprotected sex. National Youth Risk Behavior Survey (YRBS) data indicate that almost 50% of adolescents have had sex by age of 18. In addition, adolescent females are more susceptible than older women to infection because of developmental differences in the cell structure of the cervix. Research indicates that one in four sexually active youth are infected with an STD by age 24. Most chlamydia infections are asymptomatic and there are serious potential health consequences to undiagnosed infection. The clinical sequelae of chlamydia infection includes chronic pelvic pain, pelvic inflammatory disease (PID), ectopic pregnancy, spontaneous abortion, neonatal conjunctivitis and pneumonia, preterm labor and low birth weight, and infertility. Untreated infections often result in long-term consequences to sexual and reproductive health and subsequently contribute to rising health care costs. It is estimated that untreated chlamydia infection and associated sequelae costs the United States more than $2 billion per year. The burden of disease on patients, health care payers, and society is substantial and unnecessary. Addressing rising rates of chlamydia and other STDs and improving the general reproductive health of Spokane County residents by addressing risky sexual behaviors, particularly among adolescents and young adults, became a strategic priority of the SRHD’s Disease Prevention and Response Division.
Sustainability:	Stakeholder commitment: Since its inception in 2007, the STD Medical Coalition has maintained an active registry of local health providers and community partners that has expanded to 37 current members in 2011. The STDMC holds quarterly meetings to address current issues and projects, each meeting boasting between 15-27 members. STDMC’s accomplishments related to improving STD-related care in the community include development and dissemination of a quarterly newsletter, delivery of speaking engagements, participation in policy efforts surrounding the Healthy Youth Act (HYA), and participation on a community advisory board working to establish a school based health center (SBHC) network in Spokane County. Each of the aforementioned activities has involved concentrated and in-depth direction from its members. The consistent attendance and participation over the past four years demonstrates the members’ dedication to fulfilling the peer-to-peer outreach approach to meet the overall goal of improving reproductive health and reducing sexually transmitted diseases in Spokane County. Spokane Regional Health District (SRHD) as primary facilitator provides strong leadership and engages in active recruitment of new members to encourage continuing levels of enthusiasm with new ideas and work plans. Additionally, biennial STDMC membership surveys are conducted to identify membership satisfaction and interest. Results to date indicate strong commitment to the STDMC mission and vision, including direct support from members to continue collaboration in improving STD-related care within their own practices and throughout the medical community in the event of dissolution. SRHD has incorporated primary facilitation of the STDMC into the job responsibilities of the Disease Prevention and Response Health Program Specialist 2, which has scheduled funding until at least December 2013. Sustainability: Spokane Regional Health District and STDMC members are committed to broad-based involvement and participation of community partners. A strategic goal of the STD Medical Coalition for 2011 is to strengthen partnerships among community entities, including the Inland Academy of Family Physicians and the Spokane County Medical Society. Not only do these partnerships increase the Coalition’s target audience for pertinent and appropriate trainings and speaking engagements, they also provide additional fiscal resources with which to utilize in supporting projects and work plans. Several of the scheduled projects for 2011-2012 and 2012-2013, including geographically targeting neighborhoods with high health disparities to increase access to reproductive services and launching a home-collection STD testing kit program to increase access to STD testing among adolescents and rural populations, require a collaboration of efforts rather than duplication of efforts. The STDMC plans to form ad-hoc sub-committees to address each project/work plan more holistically and in conjunction with key representatives from apposite community partners. Program staff have worked hard to develop positive relationships with the Department of Health STD program and have subsequently been able to leverage additional resources to support STDMC project work. The SRHD has been the recipient of a small grant to support STDMC projects, and have received additional support in the form of patient education materials and testing/treatment resources through the Infertility Prevention Project. Relationships have also been developed with the Seattle STD/HIV Prevention Training Center (PTC). PTC staff have worked with the SRHD to bring trainings to Spokane and have also assisted with review of the STD online Toolkit. Maintaining these relationships will continue to facilitate access to resources. Additionally, the Health District staff responsible for facilitation of the STDMC actively pursue grant opportunities to support the efforts of the STDMC. The STDMC is facilitated by both a SRHD representative and a contracted physician who is also a medical director at Family Medicine of Spokane, a leading clinic in the area. In the event that SRHD is unable to continue facilitating STDMC, it is anticipated that the group could continue under the auspices of Family Medicine of Spokane.
Lessons Learned:

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