services for STDs are currently fragmented, inadequate, and sometimes of poor quality. Timely access to clinical services for STDs is vital to prevent further transmission. Access to clinical services is supported by the absence of financial barriers to obtaining health services, minimization of nonfinancial barriers, assurance that patients will not be stigmatized, and assurance that services are sensitive to sociocultural diversity. Assuring access, however, is not a sufficient method of ensuring that clinical services are effective. Providing access in both the public and private sectors allows those who need services to get them, while quality assurance improves the likelihood that services will be effective when delivered. Ensuring access to and quality of clinical services maximizes coverage and effectiveness of STD-related services. Therefore, universal and timely access to high-quality clinical services should be the goal of the clinical care system.

Under Strategy 4, the committee proposes to improve and expand clinical services for STDs by (a) ensuring access to services at the local level, (b) improving dedicated public STD clinics, (c) expanding the role of health plans and purchasers of health services, (d) improving the training of clinicians, and (e) improving clinical management of STDs.

Ensuring Access to Community Services

Access to services is facilitated by expanding availability of STD-related services through primary care clinicians and by coordinating services at the local level.

Incorporating STD-Related Services into Primary Care

Effective STD-related care encompasses biomedical interventions (e.g., diagnosis and treatment); behavioral interventions (e.g., patient counseling); and social interventions (e.g., substance use prevention and treatment). Primary care providers can be effective coordinators of these types of health and social services in the community (IOM, 1996b). This is especially important for disenfranchised persons who are at high risk for STDs and other infectious diseases and require multiple services. Because primary care treats the individual in the context of other physical and mental health problems and fosters ongoing relationships between the clinician and the individual, the likelihood of early STD detection and effective preventive interventions, such as regular clinician counseling, increases. In addition, incorporating STD-related services into primary care may improve access to services since primary care clinicians are much more numerous than public STD clinics. Primary care providers diagnose the majority of STDs in the United States, and it is likely that primary care health professionals in the private sector will play a greater role in STD prevention.

Another reason for incorporating STD-related clinical services into primary care is the wide variation in the quality, scope, accessibility, and availability of



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