Screening, Education for Sexual Perpetrators, Targeted Gonorrhea, Chlamydia Screening Discussed at NCSC

April 30, 2013 04:30 pm Matt Brown Kansas City, Mo. –

IMG delegate Alexander Brzezny, M.D., M.P.H., of Ephrata, Wash., supports an AAFP review of evidence on the effectiveness of prevention education efforts for potential sexual assault perpetrators.

Delegates from the AAFP special constituencies -- women, minorities, new physicians, international medical graduates (IMGs) and physicians interested in gay, lesbian, bisexual and transgender (GLBT) issues -- got down to business on April 27 at the National Conference of Special Constituencies (NCSC), adopting or voting down measures concerning education and health of the public issues with a limited amount of fanfare.

Education

Only a scant number of items were extracted from the Reference Committee on Education's consent calendar during the NCSC business session, and delegates voted in line with the committee's recommendations on all but one resolution.

The reference committee replaced a resolution asking the AAFP to create an educational toolkit for screening and prevention of sexual assault aimed at potential perpetrators with a substitute resolution that asked the AAFP to review evidence regarding the effectiveness of prevention education efforts targeting potential sexual assault perpetrators before anything is created.

story highlights

  • Delegates to the 2013 National Conference of Special Constituencies adopted a number of resolutions, including a resolution recommending the AAFP review evidence on the effectiveness of prevention education for potential sexual assault perpetrators.
  • Delegates also voted to recommend that the AAFP increase its online breastfeeding education efforts for patients and health care professionals.
  • Other issues the reference committee considered included the production of education materials and handouts for non-English speaking patients and behaviorally targeted, site-specific gonorrhea and chlamydia screening or testing for certain high-risk populations.

Women's constituency delegate Cathleen London, M.D., of New York, a co-author of the original resolution, took exception to the idea that further study was warranted.

"Some things you just don't need to study," she said. "When one in four college women report surviving rape or attempted rape since their fourteenth birthday, we cannot wait for a study. We are just asking for some educational guidance and awareness to be asking our young men, the same way we counsel (them) to use condoms to prevent sexually transmitted infections."

IMG delegate Alexander Brzezny, M.D., M.P.H., of Ephrata, Wash., spoke in support of the committee's substitute resolution. "I very much appreciate the intent of the committee to study the evidence on whether or not education works in this particular instance," he said. "I feel that the committee was hoping to investigate whether or not we were evidence-based in recommending that there's education for the men or for women who perpetuate these acts."

After additional discussion, the NCSC delegates adopted the substitute resolution.

Emily Briggs, M.D., of New Braunfels, Texas, seemed to sway NCSC delegates to adopt a resolution focused on online breastfeeding education for patients and providers -- against the committee's original recommendation -- after removing language regarding insurance coverage.

Briggs, a new physician delegate, said the AAFP website does not make an ample amount of information available to physicians or patients on the subject of breastfeeding.

"While FamilyDoc.org has a lot of wonderful information on breastfeeding, including some of the benefits, it is not comprehensive, and specifically, it is missing points on the process of breastfeeding," she said. "Physicians don't have (an) awareness necessarily of the existing training modules available to further instruct them on how to support and teach breastfeeding.

"The physicians involved in lactation assistance to new moms are not necessarily aware of these modules, and if you go onto the AAFP website, it is definitely not included or referenced at any point there. So the request is for the AAFP to include that information on its website," said Briggs.

Among other measures considered by the same reference committee, NCSC delegates voted to recommend that the Academy

  • identify and make available to members existing resources for the forensic exam of sexual assault and child abuse survivors;
  • endorse the participation of family physicians in the pharmacologic management of addiction; and
  • explore and develop maintenance of certification resources for members that support a broad spectrum of practice styles and areas of concentration.
[Scott Nass, M.D., speaks at NCSC in Kansas City, Mo.]

GLBT delegate Scott Nass, M.D., of Ventura, Calif., recommends annual screening and focusing specifically on men who have sex with men for behaviorally targeted, site-specific gonorrhea and chlamydia screening.

Health of the Public and Science

During the business session, delegates voted unanimously to adopt all but two of the recommendations in the consent calendar for the Reference Committee on the Health of the Public and Science, leaving substitute resolutions regarding the universal implementation of patient education materials written in Spanish and routine gonorrhea/chlamydia testing up for discussion.

After a healthy debate on the wording used to define the languages identified in the substitute resolution on education materials, the item was amended, asking the Academy to support the production of education materials and handouts for non-English-speaking patients where fiscally feasible, rather than asking for handouts to be made available in English and Spanish alone.

GLBT delegate Folashade Omole, M.D., of East Point, Ga., made a motion to amend the substitute resolution, saying that limiting the resolution to Spanish-speaking patients would be short-sighted. "I do agree that the fastest-growing population in the United States is the Latino population," Omole said. "But other populations are growing, including the Asians and the Africans … so I believe it should not just focus on Spanish. Instead, I would like it to be a comprehensive reform."

What began as a substitute resolution to recommend behaviorally targeted, site-specific (oral, rectal, and urethral) gonorrhea and chlamydia screening or testing when opting to provide such screening and testing transitioned into a debate over inclusivity versus exclusivity.

MEMBERS TWEET ALF/NCSC EVENTS

Many AAFP members who attended the 2013 Annual Leadership Forum/National Conference of Special Constituencies in Kansas City, Mo., April 25-27, were actively communicating with friends and colleagues from the conference via Twitter and other social media channels. To see a selection of member tweets for day 1(storify.com), day 2(storify.com), and day 3(storify.com) of the conference, visit the AAFP's Storify collections.

GLBT delegate Scott Nass, M.D., M.P.A., of Ventura, Calif., moved to amend the substitute resolution to stipulate that screening be performed annually, as well as to focus specifically on men who have sex with men.

"The original intent of the resolution was to specifically target a high-risk population where there is an opportunity for intervention at the public health level and where we can really make a difference," Nass said. "There's a high incidence and high prevalence of gonorrhea and chlamydia in men who have sex with men and … there is a lot of provider education that needs be done … to focus on testing sites.

"These local infections need to be tested for locally, and, from a public health perspective, we should always balance the screening opportunity with the cost and the projected benefit."

Nass also pointed out that although data from 2010 and after show that there's a high prevalence of infection in this population, current U.S. Preventive Services Task Force (USPSTF) and AAFP guidelines, which have not been updated since 2005, say there is insufficient evidence to recommend screening for gonorrhea in asymptomatic individuals.

The USPSTF recommendation on chlamydia specifically addresses protecting women.

"In the men who have sex with men population, you have an almost equal prevalence of chlamydia as gonorrhea," said Nass. "So co-testing of the two infections in the additional sites of oral and rectal, as opposed to just the urethral, which most of us are programmed to do, is our recommendation."

Women's constituency delegate Barbara Walker, M.D., of Macon, Ga., was one of several delegates who spoke against amending the substitute resolution.

"I think limiting it to just men who have sex with men is not a good idea," she said. "To my knowledge, there are no current guidelines that recommend the testing of women either, and, certainly, there are women who have anal sex as well."

In the end, the amendment was adopted, but NCSC delegates voted to refer the amended resolution to the AAFP Board of Directors for more consideration.

"It is hard for us to make scientific recommendations on the fly, and looking at the CDC website, I don't believe that this language is consistent with the CDC's screening recommendations for men who have sex with men," said new physician delegate Robert Stenger, M.D., M.P.H., of Missoula, Mont. "I want us to get the science right."

Among other measures considered by the same reference committee, NCSC delegates voted to recommend that the Academy

  • revise its current policy to recommend that all family medicine professionals counsel their patients that homes without guns are the safest -- with fewer suicides and accidental deaths -- but if people choose to keep guns, physicians should counsel families regarding trigger locks and storing ammunition separately;
  • expand the "Doctors Back to School" program and further explore similar programs to increase minority recruitment into family medicine, as well as identify best practices regarding encouraging minority students in grade school through high school to consider careers in family medicine; and
  • support amending federal law to allow for the donation of HIV-infected organs when medically appropriate to HIV-positive patients who knowingly accept the organs, as well as support the HIV Organ Policy Equity (HOPE) Act.

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