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Improving Dedicated Public STD Clinics
There is wide variation in the quality, scope, accessibility, and availability of services provided by dedicated public STD clinics, and these clinics need significant improvement. Many local health departments operate dedicated public STD clinics that are isolated from other public health and clinical services and for which quality monitoring and assessment have not been priorities. The committee supports incorporating STD-related services in primary care settings, but it also believes that dedicated public STD clinics should continue to be an important component of STD prevention. In some situations these clinics are the primary providers of STD-related services for the uninsured and provide an important focus for STD prevention in the community. In all cases, health departments operating dedicated public STD clinics should ensure that these clinics collaborate with community-based health clinics (including family planning clinics and school-based programs), university and hospital medical centers, and private sector health care professionals to improve access and quality of care. Standards to maintain access to confidential services and to monitor quality should be developed for STD-related services provided by public STD clinics, health plans, and public-private sector arrangements.
With respect to the above issues, the committee makes the following recommendations:
Based upon local conditions and health department determination, dedicated public STD clinics should continue to function as a ''safety net" provider of STD-related services for uninsured and disenfranchised persons and for those who prefer to obtain care from such clinics.
The CDC, in collaboration with state and local health departments, should ensure that services provided by dedicated public STD clinics are of high quality.
Health professional schools, including schools of medicine, nursing, and physician assistants, should partner with a local health department for purposes of STD clinic staffing, management, and professional training.
Involving Health Plans and Purchasers of Health Care
The committee believes that if certain concerns are adequately addressed, there is substantial potential for managed care to improve the quality of and access to STD-related services. Compared with other health plans, the structure and resources of most managed care organizations allow for improved coordination and integration of care, accountability of services, incentives to provide preventive services, and monitoring of service quality. However, the current performance of managed care in STD prevention has not yet lived up to its potential. With very few exceptions, STDs are not high priorities among health