In 2018, a major west coast health department engaged OnCall EOS to assist with an educational outreach campaign for syphilis and congenital syphilis (CS). They sought to employ public health detailing methods to address the unprecedented rise in the number of syphilis and congenital syphilis cases in their county. Since public health detailing builds on the successful techniques used by medical industry representatives (such as pharmaceutical representatives) to gain access to health care providers, the health department felt that a field team would provide a much-needed addition to their initiative by providing an opportunity to engage in brief encounters and tutorials with providers and enable them to advance key campaign messages and offer support.
Between 2012 and 2017 female syphilis cases quadrupled from 167 to 714 and congenital syphilis case (CS) numbers increased from 6 to 44. The department felt that a major outreach initiative could help them assess what was happening at the provider level relative to testing, diagnosis, and treatment; and enable them to provide additional guidance in these areas on a one-to-one basis.
OnCall EOS worked with the HIV and STI divisions of this major metropolitan health department to implement an educational campaign to raise provider awareness about the trends in syphilis in women in their county; and disseminate key messages around screening, staging, and treating syphilis and congenital syphilis (CS).
Additionally, the health department sought to educate providers as to the urgency of addressing the Syphilis and CS epidemic; alert them to the change in the syphilis testing guidelines for pregnant women in the third trimester (28-32 weeks); emphasize procedures for reporting positive Syphilis and CS cases to the department; offer educational resources supporting the screening, staging and treatment of Syphilis and CS; assist with linkage to care; as well as inform them of the dedicated STI nurse educator help line available to assist them with the patient treatment needs.
A “Syphilis in Women Action Kit” was developed with information on syphilis screening, staging and treatment as well as mandatory reporting guidelines, and general STD screening and treatment.
Four experienced public health detailing representatives were deployed to visit providers throughout the county. During their visits with providers, the detailers presented the resources in the action kit and employed a provider self-report assessment tool. The assessment tool surveyed: demographic information, self-reported knowledge of syphilis trends in the county, frequency of taking a sexual history, and the proportion of pregnant patients that received third trimester screening.
The field representatives completed 795 visits with health care providers over a six‐week period (432 were initial visits, and 363 were follow‐up visits which were conducted within 4‐6 weeks of the initial visit). At the follow-up visit, there was a notable increase in provider self‐reported knowledge of recent county syphilis trends; screening guidelines; and, most significantly, self‐reported use of syphilis screening for their patient population. Of the obstetricians who completed follow‐up in this phase, the self‐reported use of third trimester screening increased from 23% at baseline to 71% after receiving detailing. Additionally, provider adoption of at least one departmental recommendation rose from 34% at baseline to 78% at follow-up.
An additional benefit of deploying a public health detailing team was that the health department was able to gather actionable qualitative data that gave them insights into issues providers were having with medication acquisition; insurance coding; and insurance reimbursement. The department was able to provide direct assistance and develop additional provider tools to address these needs.
Upon final analysis of the initiative, the department determined that the use of Public Health Detailing (PHD) representatives augmented their efforts to address the syphilis epidemic in their county. Their partnership with OnCall EOS enabled the department to focus on program and policy development, provider support, and patient treatment assistance. OnCall EOS oversaw the field management, data collection, and the administrative and human resource needs of the field team. The conclusions drawn from this initiative were that use of public health detailing personnel is an effective way to reach providers and their staff to expeditiously impart critical public health messaging while gathering valuable provider experiences and practice data.