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services currently provided by many public STD clinics. However, limited research has been performed regarding the quality and scope of STD-related services in primary care settings. While the committee is optimistic regarding the ability of primary care clinicians to improve STD-related services, it recognizes that barriers to their ability to provide comprehensive services, as outlined in this report, are substantial. Although many of these barriers need to be addressed before primary care clinicians are fully able to provide comprehensive STD-related services, the committee believes that the long-term process of incorporating STD-related services into primary care should begin as these barriers are addressed.
Whether in a fee-for-service or a managed care setting, privately insured patients usually receive STD-related services as part of comprehensive primary care or, for women, gynecological care. However, such services are isolated from public sector services and broader efforts to prevent STDs in the community. With very few exceptions, it appears that private health care professionals are unaware of both the prevalence of STDs among privately insured persons and the serious and expensive sequelae of undetected infections.
Therefore, the committee makes the following recommendation:
Comprehensive STD-related services should be incorporated into primary care, including reproductive health services. Primary care should include the full range of STD-related services, including screening, diagnosis and treatment, partner notification and treatment, health education and counseling, and community outreach. Such services should be delivered by health care professionals with training in STD clinical management. These professionals may be STD specialists or primary care providers who have received STD-specific training. Regardless of the clinical setting, the provision of such services by poorly qualified health care professionals with no specific training in STDs is not recommended because it will result in inadequate diagnosis and treatment and poor coordination with other STD-related services.
Coordinating Services at the Community Level
Communities differ widely in their health needs and capacity to support a system of STD-related services. Therefore, the organization of community STD prevention services must be tailored to local needs and conditions. No single model will be appropriate for all communities. For example, only some communities will be able to depend on the teaching and research support of academic health centers that have established model STD prevention programs, including clinical capacity. Clinicians with training in STDs may be readily available in the private sector in urban areas, but difficult to find in rural areas. Communities with large numbers of high-risk persons and high STD rates may need a system of dedicated STD clinics, but communities with low STD rates may only require