Breast and pelvic exams have been a controversial topic in the last 5-10 years since cervical cytology frequency and timing have changed and since most contraceptive methods are no longer tied to cervical cytology. Because cervical cytology evaluation is less frequent, women are not always going to their clinic for their “annual” exams. When they do go to their provider, it hasn’t been clear if clinicians should perform a pelvic exam since they are not performing the cervical cytology. The American College of Physicians, the American Academy of Family physicians, the US Preventive Services Task Force, and the American College of OB/GYNs (ACOG) have varied in their recommendations. In October, ACOG updated their recommendations in their Committee Opinions, Well Woman Visit, #755 and The Utility of and Indications for Routine Pelvic Examination, #754 . ACOG advises that components of a physical examination should be a shared decision between the provider and the client, dependent on a comprehensive history. They recommend that pelvic and breast examinations be performed when indicated by the medical history or symptoms. The development and discussion of her reproductive life plan is another key component of a well woman visit to ensure testing and treatments correspond with her current and future reproductive plans. Old habits are difficult to change, but clinicians now must consider what components of an examination have value and not perform a “comprehensive” examination just because “we’ve always done it that way.”

COMMUNITY BASED SCREENING SERVICES UPDATE:

 Colleen Bornmueller, Community

Based Screening Services Coordinator



STDs are at an all-time high. Nationally combined diagnoses of chlamydia, gonorrhea and syphilis have increased over the last five years. Overall, there has been a 31% increase in these three reportable infections from 2013 to 2017. Iowa is experiencing similar trends.

 

One concept that is getting a lot of attention right now is the idea of “Express” STD clinic visits. This model is being considered as a way to see more asymptomatic patients with a reduced burden of staff time and need for full provider visits. The benefits include increased clinic capacity, decreased costs, reduced time to treatment, and reduced visit time. However, the main downside is that other diagnoses may be missed and counseling opportunities are usually at a minimum.

 

Express clinics are already being used in many locations. An express visit is usually a walk-in appointment where the patient is triaged with a series of questions to make sure there are no symptoms or known exposure that would require a full exam. If these are not present, then a provider is not needed. Many times the patients collect their own samples or specimens. This has the added benefit of reducing stigma which in turn, increases access to care.

 

There are still challenges with express visits. As mentioned, other diagnoses may be missed. Working with Electronic Medical Records can be challenging, as can having the right staffing model to process the express patient. Sometimes physical limitations of the clinic can be prohibitive to provide the space needed to manage the patients and give them confidential space to collect specimens. Opportunities may also be missed to discuss risk prevention and other services such as PrEP.

 

But with the overwhelming need to be able to see more individuals, the Express Clinic visit is under discussion. The National Association of County and City Health Officials (NACCHO) is currently conducting a project to develop a better understanding of the role of express visits and build support for providing quality STD services in this way. Their objectives include increasing the evidence base for express visits and increasing the capacity for decision-making, implementation, and evaluation of these types of visits. They are working with 15 high-morbidity jurisdictions that have implemented or plan to implement Express STD clinic visits. Three additional jurisdictions are doing more in-depth projects related to reimbursement, staffing, and marketing. You can read more about the project on the NACCHO website: https://www.naccho.org/programs/community-health/infectious-disease/hiv-sti/std-prevention

 

There are also a number of published journal articles and studies available on this subject. For more information contact Colleen Bornmueller, CBSS Coordinator at cbornmueller@fpcouncil.com

 

Alyson Simmons, Outreach Coordinator

U. S. Office on Minority Health - New Culturally and Linguistically Appropriate Standards (CLAS) Toolkit - The National CLAS Standards, developed by the HHS Office on Minority Health in 2000, include a collective set of mandates and guidelines that inform, guide and facilitate both required and recommended practices related to culturally and linguistically appropriate health services.

Highlights from the Clinical Conference at the National Ryan White Conference on HIV Care and Treatment - December 9 - 11, 2018. This annual conference aims to reach and educate HIV clinicians in the U.S. who provide comprehensive HIV care to individuals under the Health Resources and Services Administration HIV/AIDS Bureau's Ryan White HIV/AIDS Program (RWHAP) . The link will connect you to valuable online information and resources provided at this year's conference.

U.H.H.S. Funding Opportunity: Advanced Nursing Education - Nurse Practitioner Residency Grants to prepare new nurse practitioners in primary care for practice in community-based settings through clinical and academic focused 12-month Nurse Practitioner Residency programs, with a preference for those projects that benefit rural or underserved populations. The application deadline is March 4, 2019.