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Healthcare’s STD Infection Crisis – How Virtual Care Can Help

Last week, the Centers for Disease Control and Prevention announced that rates of chlamydia, gonorrhea and syphilis in the U.S. climbed for the fifth year in a row. The newly released data prompted a call for federal intervention at the 2018 STD Prevention Conference. This begs the question, how did we get here? And more importantly, what can we do about it?

STD Infection by the Numbers

In 2015, the American Sexual Health Association noted that rates of chlamydia, gonorrhea and syphilis reached a record high. And they’ve kept growing from there.

Preliminary CDC data from 2017 shows a 31% growth rate in diagnoses of these three common STDs since 2013. Individually, diagnosed cases of gonorrhea increased 67% and syphilis 76%. Chlamydia didn’t see quite the same rate of increase, but it remains the most common of these conditions with more than 1.7 million diagnosed cases in 2017.

Candy Hadsall, RN, MA, a prevention nurse specialist with the Minnesota Department of Health was at the conference and noted that the data wasn’t particularly surprising. “The CDC’s announcement that STD infection rates climbed again in 2017 just confirmed what we’re seeing in the field,” she said.

These numbers present a concerning – and initially, more than a little baffling – trend. After all, each of these infections is curable with appropriate antibiotic intervention, and the long-term effects of going untreated can be serious. So, why are infection rates continuing to grow?

The Root of the Problem

The factors influencing the increase in infections are complex and varied. A 2007 study in Sexually Transmitted Infections found an abundance of socio-demographic influences on infection rates, including race, income, gender, state of residence, age and history of incarceration. It also notes that attitudes toward sexual behavior and STD testing are prime factors in the diseases’ spread.

In the CDC’s recent announcement, Jonathan Mermin, M.D., M.P.H, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention noted, “It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point.”

At its core, the STD infection crisis is driven by this combination of attitudinal, demographic, economic and healthcare infrastructure influences.

Virtual Care’s Role in Fighting STD Infection

One of the best ways to stem the tide of STD infection is by reducing access barriers to testing and treatment, and here is where virtual care shows its value. The ways that virtual care can help patients overcome common barriers to care like geography, time and cost is well-documented. When it comes to sensitive issues like sexually transmitted diseases, virtual care can help mitigate emotional barriers, as well.

In an interview with MedCity News, Geri Lynn Baumblatt (then of Emmi Solutions from Wolters Kluwer Health) noted that patients tend to “engage in impression management” when seeing their doctor. What that means is, they try to paint themselves in the best possible light – consciously or unconsciously – in an attempt to avoid judgement and shame. While Baumblatt was speaking specifically about addiction concerns, this concept translates to sexual behavior. A solution that doesn’t require a face-to-face discussion can often produce more honest answers about sexual behavior and STD risk.

Hadsall concurs that the feeling of anonymity could help patients overcome the shame and stigma associated with STD infection. She also notes that adequate resources are a challenge in STD screening. “It’s just not possible to effectively screen everyone who should be screened,” she said. “Even at very high infectivity rates of 10-15%, that’s still 85-90 out of 100 people who are screened and test negative. With an online screening option, we could do a lot more and potentially make a real dent in STD infections.”

A Virtual Solution

Image: Stop STD Infection

Understanding the value of lowering barriers to STD testing and treatment, we developed evidence based protocols to support health systems as they work to manage steeply climbing STD rates for their patient populations. Our expedited partner therapy protocol enables patients whose partner has been diagnosed with chlamydia to get treatment. As the most commonly diagnosed STD across the country, and the one that is most frequently asymptomatic, this facilitates quick, discreet care for patients – without even requiring a test. By lowering barriers to receiving care for known chlamydia exposure, health systems can help reduce the continued spread of chlamydia.

We also recently created an evidence-based virtual care STD testing protocol that gathers risk assessment data and enables patients to access lab tests for chlamydia, gonorrhea and syphilis. This protocol leverages lab integration workflows to capture patient information and seamlessly route them to a lab location for testing. Our aim is to help health systems use the asynchronous patient interview to overcome the embarrassment patients feel talking about STDs, potentially increasing the likelihood of individuals to seek testing.

The continued rise of STD infections is a complex issue, impacted by everything from socio-cultural norms to poverty rates and education to healthcare access. It may feel overwhelming, but looking at individual pieces can still make a sizable impact. There are many factors virtual care can’t impact. What we can do is help take the strain off of the systems currently unable to manage this growing health crisis and lowering barriers to STD testing and treatment.

Virtual Care and Public Health: Helping Manage a Measles Outbreak in Minnesota

You may have heard that our home state of Minnesota is in the grip of a measles outbreak – primarily in the Twin Cities metro area, though there are several cases in outlying counties. As I write this, there are 78 confirmed cases of measles, and the number is growing. I’m not going to get on a soap box about vaccination (though, the vast majority of patients were, unsurprisingly, unvaccinated). Instead, I’ll use this example to illustrate the role of virtual care in a public health crisis like this one.

How Virtual Care Can Help

When managing certain outbreaks of infectious conditions, the value of virtual care is two-fold. First, it provides a unique channel for evaluating potentially contagious patients, taking them out of the waiting room and limiting the opportunity for infections to spread. This is particularly important when a communicable disease is active (think cold and flu season). By directing patients to the virtual visit, rather than into clinics, virtual care can help health systems curtail the spread of illnesses like influenza.

Second, and most important in this recent measles outbreak, it offers a front-line communication channel for health systems to share critical information with their patients and the community.

The early symptoms of measles are very similar to those of an upper respiratory infection – one of the top conditions patients seek treatment for via the Zipnosis platform. We collaborated with one of our Twin Cities clients to find a solution that we could deploy quickly to help manage communication about the outbreak. This is particularly important, since Minnesota medical regulations allow any person to seek virtual care or telemedicine; some states require a person to have an established relationship with a clinic to be eligible for virtual care.

Through collaboration with our health system client, we rapidly developed and deployed an online messaging feature enabling health systems using the Zipnosis platform to share important information about the measles outbreak for patients using the virtual visit system. Accessible and editable by staff within the health system, our Minnesota clients are now using this functionality to provide important patient alerts about the measles outbreak and to educate them about early symptoms, dangers, and the steps they should take if measles is a possibility.

This new feature goes beyond this one outbreak or use. Health systems can now relay information about other things their patients may need to know: updates on allergen and pollen levels, reminders to get a flu shot prior to flu season, or information on seasonal diseases like Lyme disease and other outbreaks.

Public Health and the Potential of Virtual Care

Virtual care is more than a technology – it’s a digital care delivery channel, just as important to supporting health outcomes as a nurse line or clinic. And, as patients continue to adopt virtual care in greater numbers, its value as a channel for communication, education, and care delivery will increase too.

Today, we see nearly limitless possibility for virtual care to support health systems and providers as they work to drive positive health outcomes for their patients and communities. Health systems are just beginning to understand how they can use virtual care to do more than treat common conditions, and we are excited to help them realize this potential. While this particular feature may not be a groundbreaking industry disruptor, it gives our health system clients another option for supporting the health of their communities – and to us, that’s huge.

About the Author

Kevin Smith, Zipnosis Chief Clinical Officer

Kevin Smith, Chief Clinical Officer at Zipnosis, has been a leader in innovative care delivery since 1999. In both clinical practice and his doctoral studies, he has focused on innovative applications of technology, clinical decision support, and analytics to drive clinical quality improvement. Dr. Smith is adjunct faculty at the University of Minnesota School of Nursing, a Fellow of the American Association of Nurse Practitioners, and a member of the American Telemedicine Association, HIMSS, AMIA, and the National Speakers Association.