Sexually Transmitted Diseases  >  Program Guidelines  >  Partner Services

Program Operations Guidelines for STD Prevention
Partner Services

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Sections on this page:

• Post-interview Activities
• Documentation
• Analysis of Case Information and Problem Solving
• Prioritization of Partners, Suspects, and Associates
• Obtaining Further Information
• Using Information Obtained From the Interview to Identify Possible Outbreak Situations
• Lot System: A Case Management Tool
• Lot System Forms

Post-interview activities

Documentation

Documentation is the careful and complete recording of facts surrounding a particular case or investigation and includes the essential events leading to its closure. DIS should concisely and legibly document the results of interviews, including case analysis, on the interview record and related program forms at the first reasonable opportunity (not to exceed one workday) consistent with established policy. Information to document includes unexplained exposure gaps, clustering needs or opportunities, and other information needs. The interview record and related forms are never completed in the presence of the patient. It may be helpful to review related cases and discuss the current interview with a supervisor or co-worker before completing the case write-up. Once all the paperwork necessary to fully document the initial interview has been completed, the entire case—including all field records and, where appropriate, a completed confidential morbidity report card—should immediately be directed to the attention of the supervisor for necessary review and comment. Proper documentation promotes effective disease intervention efforts through the efficient sharing of information with others—allowing co-workers to build on what has already occurred without having to needlessly repeat steps or actions already taken.

Interview and field records, whether on paper or in an electronic format, must be viewed as legal and confidential documents. As such, every effort must be made to ensure that each record is complete, accurate, fully legible, and able to stand the test of careful scrutiny. Interview records should be maintained in a secure location, accessible to the DIS and supervisors. DIS should review open cases at least twice weekly to determine status and evaluate needs. Such reviews enable reinterviews and cluster interviews to be easily and effectively planned. Supervisors should also regularly review cases and should clearly date, record, and initial all comments and directions. Whenever possible, supervisors should be encouraged to review cases in the presence of the responsible interviewers.

Information obtained from well documented interview and field records enables programs to make the most efficient use of resources by identifying and then targeting locations or specific populations within the community for screening activities. It also affords programs the opportunity to identify and draw upon additional resources and support by developing collaborations with carefully selected community-based and related organizations serving particular communities or at-risk populations.

Analysis of case information and problem solving

Information obtained from medical records, interviews, reinterviews, and cluster interviews must be carefully analyzed for consistency. Visual case analysis (VCA) is an essential tool in syphilis case management for analyzing data from multiple sources. VCA allows the DIS to systematically document medical and epidemiologic facts related to early syphilis cases, analyze those facts, determine the most likely hypothesis of disease spread, identify where disease intervention could occur, and develop a plan for action. Information that is conflicting, unclear, or absent, but pertinent (for example, patient address(es), number of partners, descriptions of a partner, locating or exposure information) should be analyzed. In many instances, these issues can be quickly and easily clarified by speaking with the patient. There may be occasions, however, where the DIS chooses to explore other avenues before returning to the patient. Strategies for resolving inconsistencies in case management information include the following.

• Reinterviewing individuals who give sketchy information or whose partners give discrepant information.
• Offering field tours to patients in an effort to gain more complete locating information and to identify locations where the at-risk population gathers. These locations may become possible sites for targeted outreach activities.
• Performing an unannounced home visit for purposes of reinterview and to confirm the patients address and living situation.
• Clustering partners, suspects, and other individuals not named by the original patient (roommates, family members, neighbors, etc.) in an attempt to gain additional information about the original patient and the at-risk community. This is done with the understanding that some individuals can be expected to provide greater insights and information than others. For example, spouses and roommates should be considered for initiation and clustering even when exposure is denied by the index patient.

Prioritization of partners, suspects, and associates

Once field records have been completed for notification of partners, suspects, and associates, they should be carefully prioritized to ensure that those at highest risk—those who are pregnant, those exposed to lesions, or those indicated to have suspicious symptoms —are contacted or interviewed first. The prioritization of partners should be based on local program area policy and DIS workload using the same principles for priority setting discussed earlier.

Some program areas assign all field records (FRs) resulting from patient or cluster interviews to the interviewing DIS. However, if the number of priority partners or suspects is more than can reasonably be followed up in a 24-hour period, the immediate supervisor should assign some of the investigations to others. Priority suspects are individuals not named as sex partners, but who are identified as having suspicious symptoms (S-1) or as being an unnamed sex partner of another known case (S-2).

Quality analysis can only take place when interview records and supporting forms are properly completed and fully documented. A complete visual case analysis an be invaluable in documenting risk patterns in complex clusters of sex and STD transmission. Programs are encouraged to collect risk-behavior information on the interview record (i.e., with respect to drug use, the type of substances used and date of last use; whether the patient exchanged sex for drugs or money, or has had sex with someone or a partner of someone who exchanges sex for drugs or money). Important patient information should also identify the patient's usual health care provider and should provide sufficient space to fully document marginal partners. Collecting that information will assist program efforts to better understand the risk factors associated with various STDs.

Obtaining further information

DIS should tell all patients that it may become necessary to speak with them again and should attempt to determine the best way for doing so. Patients should be contacted the day following treatment to inquire about any reaction to medications, to answer any questions that may have come to mind, and to seek clarification concerning partner locating information as needed. Follow-up after diagnosis underscores program concern for the patient as an individual. Rapid follow-up about partner locating information reinforces the urgent nature of partner notification. It provides an opportunity to follow up on how patients are doing with any commitments made; and affords an opportunity to review locating information already provided and to ask about additional partners that may have come to mind. If the original patient inquires about the status of partners that have been identified, the only information that may be relayed is whether the partners have or have not been notified.

Using Information Obtained From the Interview to Identify Possible Outbreak Situations

Programs should pursue information that will delineate at-risk populations so they might be more easily and effectively targeted for a wide range of interventions. This information can be obtained through community outreach activities, clustering, and increased testing by providers beyond the public STD clinic. Patients, their partners, and cluster suspects and associates can be particularly helpful in program efforts to identify specific at-risk populations in need of special initiatives. For example, a program may consider designing, evaluating, and implementing specific forms to identify and to assure the routine and continuing examination of sex workers within a particular community or program area.

Lot system: a case management tool

A lot system requires that case management records be maintained in a single folder. The goal of a lot system is to assure that all obtainable information regarding the continuing management of cases contained in a lot is readily available to all responsible workers. Workers should have access to information regarding other infections so that they have a comprehensive picture of the situation before conducting a reinterview or cluster interview. To further assure this process, information contained within each lot must be carefully maintained for each individual patient, and lots must be returned to a secure central location (file) when not being reviewed or updated. The lot system is a very useful tool in the management of syphilis, particularly in larger program areas or in areas with high syphilis morbidity. While it is most often used for syphilis, the lot system may be used for other diseases as well. Lot systems can facilitate identification of populations for which targeted screening is a suitable intervention.

The decision to file cases together can be for any "logical" reason, for example: 1) patients are related, i.e., they name one another as sex partners or are linked through clustering or 2) cases share something in common, such as working for the same company or living in the same apartment building.

The individual folders that constitute the lot system should be filed sequentially, by date reported. A "lot book", card file, or computerized system should be established, with information such as lot number, patient name, date of interview, diagnosis, etc. This system can be referred to when attempting to locate a particular interview record. When information allows cases in two or more lots to be "collapsed" into a single lot, the lot folder containing the most recently initiated case should normally be selected. The folders for those cases being moved should be retained in the file, with the lot number to which the case was moved written on the front.

With the increasing use of computers to store patient records, the use of an electronic lot system simplifies tasks. This may be accomplished by assigning a lot number in a local use field and then assigning the same number to all of the related records. When the records are sorted by the lot number, all of the records in that lot should be listed. A system should exist, either electronic or as hard copy, to cross-reference patient names, lot numbers, and case numbers.

Lot system forms

A major analytical points (MAP) sheet is used for gathering information about members of a lot as well as for analysis and communication. The MAP sheet is a preprinted list of items that are frequently needed in case management. Spaces are provided for other items unique to the lot. In addition, cluster and reinterview records may contain information that may generate agenda items during an interview of another patient in the same lot. These forms also may be used to document what occurred during the same interview. The original patient information sheet, along with the original interview record provides important disease intervention information. The lot folder status sheet is both a reminder of cases in the lot and a summary of their relationships. Recent examples of these forms from the state of California, along with a field record form and a syphilis case management sheet, can be found in Appendix E.

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