NR 503 Discussion Presentation of Epidemiological Problem Abstract

The United State is spending close to $16 Billion dollars annually on sexually transmitted diseases (STDs) (Centers for Disease and Prevention [CDC], 2017). Southern states, like Georgia, sees a large number of syphilis cases. Surprisingly, there was once a time where syphilis was at its lowest and was on the verge of elimination. Now, the rates of syphilis have doubled, causing an incidence rate in the U.S of 5.5 cases per 100,000 (CDC). Men have the highest prevalence. Their rates have continued to climb. Men who have sex with men or MSM are at the greatest risk and have the highest rates of syphilis with 15.6 per 100,000 or 88.9% of all U.S. cases (CDC, 2017). This has been termed a MSM epidemic. A rapid plasma regain (RPR) is the lab of chose to routinely screen for syphilis. Once diagnosed there are 3 main stages: primary, secondary, and latent. Treatment dosage varies but the treatment of choice is Penicillin Benzathine G given intramuscularly. Once there is a positive lab and confirmation lab, it must be reported by law to the state’s public health department. This is normally done by the laboratory and physician. There is an electronic system where this is transmitted through. After being reported, it is then used for surveillance. It is the goal of providers to help educate the community on syphilis awareness. Patients must be open to talk about their sex health with their providers. Three ways to work towards the goal of syphilis prevention are: to provide information and encourage safe sex, screen for all STDs, and lastly, treat the patient and notify their partners. These actions will limit the exposure and transmission of syphilis; therefore, decreasing the rates of syphilis in Georgia and the U.S.

Resource

Centers for Disease and Prevention (CDC). (2017). Sexually Transmitted Disease (STDs). Retrieved from https:www.cdc.gov/std/syphilis/defualt.htm

After I read your and Darnesha’s post, I looked up the statistics of syphilis in Georgia State. I found out that Georgia ranked 1 among 50 states at least one case of primary and secondary syphilis in the United States (CDC, 2013). In Georgia, African American had the highest incidence rates with 25.5 per 100,000 population, 34.1 among Native Hawaiian/Other pacific Islanders, and 5.1 among Hispanics/Latinos (CDC, 2013). I was very surprised by these numbers and was reminded myself again that educating people who have lack of support and resources about the prevention disease are an important factor to reduce the incidence rate of STDs. In order to do that, healthcare providers at local and community center clinics should provide equal care to vulnerable and minority groups so everyone will get an equal chance to be healthy regardless of their background including religion, ethnicity, gender, income, disability, and sexual identity. Enjoyed reading your post. Thank you !

Centers for Disease Control and Prevention (CDC). (2013). Georgia, 2013. Retrieved from https://www.cdc.gov/std/syphilis2013/GA13.pdf

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I agree that it will be paramount for advanced practice nurses (APNs) to understand disease process so that they aid in decreasing transmission of disease. It will also be important that they understand the role disparities play in the epidemiological and disease process. Take for example, in a study conducted by Green, Levin-Rector, Hadler, and Fine (2015), 18 out of 41 communicable disease in New York City (NYC) were found to correlate with high poverty rates. This helps to demonstrate the effects poverty has on disease, supporting that disparities may have an instrumental impact on transmission of disease, as it may limit access to care, or places patients at higher risk for a disease. APNs will be leaders within addressing and revealing disparities so that they are decreased within the communities and populations they serve, seeking to increase the health and wellness of all individuals.

During this week’s lesson measurements of outcomes were discussed. Through this I was able to learn key elements of measurable outcomes. The lesson also identified outcomes can be measured specifically both individually or within groups as they aid within development of patient care practices. It will be important for APNs to measure outcomes so that quality of care is maintained. As the measurable outcomes now no longer revolve around mortality rates, but have shifted to a patient-centered care model. As the study by Rutten, van Vugt, Weerdt, and de Koning (2018) discovered, patients were more satisfied when the visits revolved around them and their thoughts on care, as well as sharing decisions with the physicians (2018). Comparison of outcomes will be paramount as they support patient care practices. APNs will need to also be knowledgeable about organizations that support comparison of outcomes so that patient practices and guidelines support evidence-based practice. Take for example, the Patient-Centered Outcomes Research Institute (PCORI) is organization that seeks to support outcomes research in clinical practice take into account patient providers and perspective into research so that patient-centered outcomes can arise (Frank, Basch, & Selby, 2014). Outcomes will seek to drive quality driven practices and aid in critical thinking so that patients receive optimal patient care and treatment. APNs will have the resources available to them to support them in measurement of outcomes. Measurable outcomes will be paramount as APNs appraise healthcare interventions so that they support safe healthcare practices.

References:

Frank, L., Basch, E., & Selby, J. V. (2014). The PCORI perspective on patient-centered outcome research. Journal of the American Medical Association, 312(15), 1513-1514. doi:10.1001/jama.2014.11100

Greene, S. K., Levin-Rector, A., Hadler, J. L., & Fine, A. D. (2015). Disparities in reportable communicable disease incidence by census tract-level poverty, New York City, 2006-2013. American Journal of Public Health, 105(9), 27-34. doi:10.2105/ajph.2015.302741

Rutten, G. M., van Vugt, H. A., de Weerdt, I., & de Koning, E. (2018). Implementation of a structured diabetes consultation model to facilitate a person-centered approach: Results from a nationwide Dutch study. Diabetes Care, 41(4), 688-695. doi:10.2337/dc17-1194

I was shocked to read these statistics regarding syphilis and the fact that an almost extinct disease now has a doubled rate and is considered an epidemic among MSM men. Dr. Anttila, I couldn’t agree more that although it is very important we have an advanced level of knowledge regarding syphilis and other STD’s it is crucial that we understand how disparities among different populations can impact their risk for contracting a STD. Darnesha you had great suggestions on reducing the incidence of syphilis. First and foremost, education is key. This education needs to be targeted at the population most at risk and provide resources for further information, counseling, etc. You mentioned screening for all STD’s and I think this is also crucial. The CDC’s current recommendations for different STD’s are not as inclusive as they should be, in my opinion, and this hinders physicians in asking the right questions, offering the right screening, and appropriate counseling. Providing easy access screening or even screening drives in impoverished or high risk areas would be very beneficial. Also, in my experience with my own teen, she did not realize that partners can be anonymously treated (Katz, 2014). Through this option partners of those who test positive can receive medication anonymously without ever having to be tested or see a physician. Of course this brings up the issue of antibiotic allergies or overuse but when considering the pros and cons of treating even a possible STD far outweighs the possible negative implications.

Thank you for a very informative post Darnesha.

Katz, A. R. (2014). Insights in public health: The hidden epidemic: sexually transmitted diseases in 2014. Hawai’i Journal of Medicine & Public Health: A Journal of Asia Pacific Medicine & Public Health, 73(8), 265-267.

Thank you for a very informative post Darnesha.

The USPSTF website (updated as recent as June 2016) is very helpful to APNs and has an easy search method for APNs to access information about recommendations for primary care practice. I could not locate any direct information on arthritis prevention, screening, or care out of the 101 entries, but I did find entries about health conditions related to arthritis. These recommendations advise that all older patients (irrespective of whether or not they have arthritis) receive services of interest. There are entries for sexually transmitted diseases, “Syphilis Infection in Nonpregnant Adults and Adolescents: Screening” and “Chlamydia and Gonorrhea: Screening.” According to the recommendation from the USPSTF (2016) on screening for syphilis, populations at greater risk for syphilis are people diagnosed with human immunodeficiency virus (HIV) infection, men who have sex with men, and men in their 20s who reside in urban areas or cities and who have a history of incarceration. The USPSTF provides information for a number of syphilis screening tests. APNs who have clients who fit these categories should recommend screening for syphilis. In a primary care setting, USPSTF guidelines suggest primary care providers perform a nontreponemal test (RPR or VDRL) first. If this test comes out positive, a treponemal antibody test (FTA-ABS or TPPA) should be performed next. USPSTF guidelines state these two tests should not be conducted at the same time. The USPSTF (2016) found no direct harms of screening for syphilis; however, possible harms listed are “false-positive results, anxiety, overtreatment, and harms linked with receiving antibiotic treatment.”

References

U.S. Preventive Services Task Force. Screening for syphilis infection in nonpregnant adults and adolescents: U.S. Preventive Services Task Force recommendation statement. JAMA. 2016;315(21):2321–2327. Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/syphilis-infection-in-nonpregnant-adults-and-adolescents?ds=1&s=

NR 503 Discussion Presentation of Epidemiological Problem Abstract