Improving Office-based Physicians' Prevention Practices for Sexually Transmitted Diseases

1 October 1994 | Volume 121 Issue 7 | Pages 513-519

Objective: To determine whether office-based interventions increase primary care physicians' risk assessment of and counseling practices for patients regarding sexually transmitted diseases and the human immunodeficiency virus (HIV).

Design: Randomized controlled clinical trial.

Setting: Washington, D.C., Metropolitan Statistical Area.

Study Participants: Office-based primary care physicians (family or general practice, internal medicine, and obstetrics-gynecology).

Intervention: Mailed educational materials alone or coupled with a simulated patient instructor office visit.

Measurements: Self-reported and observed frequency of assessing and counseling patients regarding their risk factors for sexually transmitted diseases and HIV infection. Participants were interviewed by telephone before and after the intervention (n = 757). A subset of participants (n = 194) was also observed after the intervention by simulated patient evaluators in blinded office visits.

Results: 89% of physicians who received both educational materials and a simulated patient instructor visit reported that they reviewed the educational materials compared with 53% of those who only received the educational materials (P 0.001). Physicians in the combined intervention group had higher self-reported and observed rates for several risk assessment questions and counseling recommendations than did physicians in the control group or the group that only received educational materials. Seventy-three percent of physicians of the combined intervention group reported an increase in counseling patients about reducing risky sexual behavior compared with 53% of the group receiving only educational materials and 42% of the control group (P 0.001).

Conclusions: Mailed educational materials combined with an office visit by a simulated patient instructor for role-play and feedback on clinical performance increased the frequency of office-based physicians' risk assessment and risk reduction counseling of patients for sexually transmitted diseases and HIV infection.

Author and Article Information

From Georgetown University School of Medicine and the George Washington University Medical Center, Washington, D.C., and the Bowman Gray School of Medicine, Winston-Salem, North Carolina.
Requests for Reprints: David L. Rabin, MD, MPH, Department of Family Medicine, Georgetown University School of Medicine, 3750 Reservoir Road, Northwest, Kober-Cogan Room 417, Washington, DC 20007.
Acknowledgments: The authors thank the technical assistants on this project: Rachel Burnett, Alex Kral, and Ishrat Rafi.
Grant Support: By grant R18 A124403 from the National Institute for Allergy and Infectious Diseases and a donation from the Gannett Foundation.