Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Public Health Rep. 2023 Mar-Apr;138(2):232-240. doi: 10.1177/00333549221081130. Epub 2022 Mar 10.
Public health detailing is an intervention in which a public health professional visits health care providers to educate them about evidence-based approaches to improve health. The San Francisco Department of Public Health conducted a public health detailing program from 2016 to 2018 to improve sexual health care and preexposure prophylaxis services in the city.
We conducted a mixed-methods study to understand the implementation of detailing and explore examples of changes to clinicians' clinical behaviors. We surveyed 203 clinicians, conducted 60-minute qualitative interviews with 7 clinicians and 4 detailers, and analyzed tracking forms. We used descriptive statistics to assess associations in the surveys. We used qualitative thematic analysis to understand facilitators and barriers to detailing and identify ways to improve the process and identify its potential benefits.
In interviews, both clinicians and detailers had a favorable view of detailing as a tool to connect health department expertise to clinicians. Detailers cited challenges such as limited clinic time, provider turnover, and policies that limit their access to clinicians. These challenges may attenuate the real-world benefits of detailing. Clinicians offered examples of how detailing altered their behaviors, such as taking sexual health histories, building knowledge and confidence about sexual health, and using health department services. Matched surveys (n = 21) showed preliminary changes to prescribing preexposure prophylaxis.
Public health detailing is a promising approach to increase clinicians' knowledge and confidence to offer sexual health care services, build buy-in, and support connection to health departments. Detailing programs require sufficient investment and staff support to build lasting and collaborative relationships between clinicians and public health departments and to assess the impact of the intervention.
公共卫生详述是一种干预措施，其中公共卫生专业人员访问医疗保健提供者，教育他们有关循证方法，以改善健康。旧金山公共卫生部在 2016 年至 2018 年期间开展了一项公共卫生详述计划，以改善该市的性健康护理和暴露前预防服务。
我们进行了一项混合方法研究，以了解详述的实施情况，并探索改变临床医生临床行为的示例。我们调查了 203 名临床医生，对 7 名临床医生和 4 名详述者进行了 60 分钟的定性访谈，并分析了跟踪表格。我们使用描述性统计来评估调查中的关联。我们使用定性主题分析来了解详述的促进因素和障碍，并确定改进该过程和识别其潜在益处的方法。
在访谈中，临床医生和详述者都对详述作为一种将卫生部门专业知识与临床医生联系起来的工具持有利看法。详述者列举了一些挑战，例如诊所时间有限、提供者更替以及限制他们与临床医生接触的政策。这些挑战可能会削弱详述的实际效果。临床医生提供了详述如何改变他们行为的示例，例如进行性健康史、建立对性健康的知识和信心以及使用卫生部门服务。匹配的调查（n = 21）显示了处方暴露前预防措施的初步变化。
公共卫生详述是一种很有前途的方法，可以增加临床医生提供性健康护理服务的知识和信心，建立认同，并支持与卫生部门的联系。详述计划需要足够的投资和人员支持，以建立临床医生和公共卫生部门之间持久和协作的关系，并评估干预措施的影响。
