Intensive Long-Term Evaluation

National Network of Sexually Transmitted Disease Clinical Prevention Traning Centers (NNPTC)

Att 16_Intensive-Long Term Evaluation-2022

OMB: 0920-0995

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OMB Control Number 0920-0995

Exp. Date 06/30/2023

TODAY’S DATE

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Intensive Long-Term Evaluation



A1f. The training is relevant to my work.

strongly disagree

Strongly agree





A2f. The training improved the way I do my work.

strongly disagree

Strongly agree





A3f. I am using what I learned in this training in my work.

strongly disagree

Strongly agree




A3fa. If you have not used what you learned, please explain why not.____________________________________


A4f. In the prior evaluation, your response to the following question, “do you intend to make changes in your practice or at your worksite setting”, was <insert user’s response from immediate post evaluation>. (Skip for those who do not have piped response from Post evaluation)

Were you able to make this change?

Yes

No


A4fa. If No, please explain?­­­­­­­­­­­____________________________________


A5f. As a result of the training, did you make changes in your practice or at your worksite? (Skip for those who answer A4f)

Yes

No

Not my job

Other reason (please specify)____________________________________


A5fa. If yes, what change(s) did you make?­­­­­­­­­­­____________________________________




As a result of the information presented did you…


Yes

No

I was already doing this

SGCH1

Use the CDC STD Treatment Guidelines in your practice?

1

0

2

SGCH2

Download the CDC STD Treatment Guidelines app?

1

0

2

SGCH3

Use the STD Treatment Guidelines wall chart or pocket guide?

1

0

2

SGCH4

Send a consult to the STD Clinical Consultation Network? www.stdccn.org

1

0

2



As a result of the information presented did you… (Select ‘Not Applicable’ if the training did not cover the content area listed)

Yes

No

I was already doing this


N/A

SGCH5

Increase the proportion of your sexually active asymptomatic female patients under age 25 screened annually for urogenital chlamydia and gonorrhea?

1

0

2

3

SGCH6

Increase the proportion of your male patients who have sex with men screened for syphilis, gonorrhea, and chlamydia at least annually?

1

0

2

3

SGCH7

Use CDC-recommended antibiotic therapy to treat uncomplicated gonorrhea?

1

0

2

3

SGCH8

Recommend rescreening in 3 months following a gonorrhea, chlamydia or trichomonas diagnosis?

1

0

2

3




A6f. Did any of these factors MAKE IT HARDER for you to incorporate the STD practices recommended in the presentation? (select all that apply)

 Lack of time with patients

 More important patient concerns

 Cost/lack of reimbursement

 Policies where i work

 Resistance to change by supervisor or colleagues

 Lack of equipment or supplies

 No opportunity to apply practices

 I did not feel confident

 Coworkers need training

 Nothing interfered

 other, please specify ___________________________________________________



A7f. Did any of these factors HELP you incorporate the STD practices recommended in the presentation?

(select all that apply

 Reimbursement or other financial incentive

 Support of supervisor and/or colleagues

 Standing orders

 Reminder in chart

 Convenient supplies

 Posted patient instructions for obtaining specimens

 Electronic health system

 Knowledge/Confidence gained from training

 Trained coworkers

 Nothing specific helped

 Other, please specify ___________________________________________________



The following questions ask about screening rates. Please select the range that is the best estimate of your screening practice.


PPC1f Now, 3 months AFTER training, approximately what % of sexually active asymptomatic female

patients under age 25 are you screening annually for chlamydia?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPC2f Now, 3 months AFTER training, approximately what % of pregnant patients under age 25 are you

screening for chlamydia?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPG1f Now, 3 months AFTER training, approximately what % of sexually active asymptomatic female patients

under age 25 are you screening annually for gonorrhea?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA




PPG2f. Now, 3 months AFTER training, approximately what % of pregnant patients under age 25 are you

screening for gonorrhea?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPG3f Now, 3 months AFTER training, approximately what % of your male patients who have sex with men

are you screening annually for gonorrhea and chlamydia?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPS1f Now, 3 months AFTER training, approximately what % of your male patients who have sex with men are

you screening at least once a year for syphilis?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPS2f Now, 3 months AFTER training, approximately what % of your pregnant patients are you screening for syphilis?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPS3f Now, 3 months AFTER training, approximately what % of your patients recently diagnosed with

syphilis are you testing for HIV?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPHPV1f Now, 3 months AFTER training with approximately what % of your non-vaccinated 11 to 26 year-old

female patients are you discussing HPV vaccination during a preventive health visit?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA


PPHPV2f Now, 3 months AFTER training, with approximately what % of your non-vaccinated 11 to 21 year-old

male patients are you discussing HPV vaccination during a preventive health visit?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPHPV3f Now, 3 months AFTER training, with approximately what % of your non-vaccinated male patients

age 26 or under who have sex with men or are HIV+ are you discussing HPV vaccination during a

preventive health visit?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA




PPSH1f Now, 3 months AFTER training, for approximately what % of patients older than 15 seeing you for a

preventive health visit do you take a sexual history that asks about behaviors that would put them at risk

of getting or transmitting an STD?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



PPSH2f Now, 3 months AFTER training, for approximately what % of patients older than 15 seeing you for a

Preventive health visit do you take a sexual history that asks whether they have had oral, vaginal, or

anal sex?

0%

1-25%

26-50%

51-75%

76-90%

>91%


NA



EXPEDITED PARTNER THERAPY


EPTf As a result of the information presented do you intend to provide Expedited Partner Therapy (EPT) to

heterosexual partners of those diagnosed with gonorrhea and/or chlamydia?

Yes

No

Not applicable to my practice or job

Not allowed in my state/practice

My practice/worksite is in the planning stages to offer EPT

My practice/worksite already offers EPT

EPT was not discussed




File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorAriyo, Oluwatosin (CDC/DDID/NCHHSTP/DSTDP)
File Modified0000-00-00
File Created2023-08-27

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