The case finding effectiveness of a self referral system for gonorrhea: a preliminary report

Our purpose was to examine the efficacy of an alternative to the standard case interview and investigation. Although we recognized from the outset that a short term evaluation could not provide data on disease control, we were able to evaluate the ability of the alternative to detect new cases, and on that basis we developed a sense of its comparative effectiveness and cost. Our data suggest that in this setting, the self referral system is as effective as the standard interview in bringing infected partners of male heterosexual patients to treatment. In fact, by all parameters examined contacts elicited, contacts initiated, contacts seeking medical care, contacts infected, and cost the self referral system did as well or better. Unfortunately, in prior experience with self referral, emphasis has been on the referral slip, rather than on the selfreferral process itself. The return of slips in this study was actually a poor indicator of the efficacy of the system. Through discussions with patients, the clinic staff learned that the slip per se, was often irrelevant and at times a detriment. Contacts often refused the slip, but sought care. The 'process' motivated 86 of the 116 contacts in the Study group, although only 12 slips were actually returned to the clinic. The referral slip may have been important in establishing a 'contract' between the original patient and the health department, but it was not important to the patient's referral of contacts.