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The Changing Paradigm of Sexually Transmitted Disease Control in the Era of Managed Health Care
Robert A. Gunn, MD, MPH;
Robert T. Rolfs, MD;
Joel R. Greenspan, MD, MPH;
Robert L. Seidman, PhD;
Judith N. Wasserheit, MD, MPH
JAMA. 1998;279:680-684.
Several trends in sexually transmitted diseases (STDs) have laid the foundation for a new paradigm for STD treatment and prevention that encompasses a community-wide, population-oriented approach. Public health STD programs, in partnership with a wide variety of community collaborators, will need to carry out the essential functions of public health—assessment, policy development, and assurance—by developing resources for community organizing and planning, enhanced information systems, and comprehensive training programs for professional staff and community partners. Community providers (particularly practicing clinicians and community and hospital clinics) will need to deliver primary prevention (community health promotion and clinical preventive services) and secondary prevention (screening and treatment) services while categorical STD clinics focus on providing care for high-risk, high-frequency STD transmitters who serve as the reservoir for much of a community's bacterial STDs. Managed care organizations and public health STD programs will need to formalize collaborative arrangements and capitalize on the strengths of each organization in order to have a population-level impact on STD transmission.
From the Division of STD Prevention, National Center for HIV, STD, TB Prevention (Drs Gunn, Greenspan, and Wasserheit), and the National Center for Health Statistics (Dr Rolfs), Centers for Disease Control and Prevention, Atlanta, Ga; the Health and Human Services Agency, San Diego County, San Diego, Calif (Dr Gunn); the Utah Department of Health, Salt Lake City (Dr Rolfs); and the Graduate School of Public Health, San Diego State University (Dr Seidman).
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