Public Health Detailing: Building Partnerships to Improve Health Outcomes in a Rural State

Background:  In New Hampshire, 50% of people who are newly diagnosed with HIV infection develop AIDS within one year, indicating they have had the virus for a period of time.   Additionally, some providers may be challenged with implementing appropriate treatment for sexually transmitted diseases (STD).   During one quarter, over 60% of patients diagnosed with gonorrhea received inappropriate treatment.  Early identification of HIV infection and implementation of the current STD screening/treatment guidelines will assure  clients have access to appropriate care and linkages with prevention and partner services to reduce the likelihood of disease transmission. 

Methods:  The New Hampshire Division of Public Health Services (DPHS) launched a Public Health Detailing (PHD)Program in 2014.  The goals are to: 1) Improve screening and management of infectious diseases, and 2)  Build partnerships with primary care.  A Public Health Nurse visits with providers to provide data and updated STD/HIV/Hepatitis C screening and treatment guidance.  

Results:   The PHD Program has evolved over a 15-month period.   Of the 79 visits made, 57% (45) were in-person meetings with providers, while 43% (34) were drop-in visits.    A total of 218 providers received education or technical assistance.  Approximately 55% of providers  are not routinely offering HIV testing and 65% are not routinely offering Hepatitis C testing to patients born between 1945-1965.   These data underscore the need for provider-focused education on screening recommendations. Evaluation data for presentation will include satisfaction feedback from providers, percentage of providers with a knowledge shift, percentage of providers with intention to adjust practices and percentage of providers that have implemented change as a result of the visit. 

Conclusions:   The PHD model can be conceptualized to virtually any topic.  In addition to education, the physician-focused intervention identifies opportunities for integration with primary care to align leadership, build community engagement and improve health outcomes.