This proposal completes the intervention and evaluation phases of a stepped educational program to improve primary care physicians' prevention of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection in adult patients through improving physicians' sexual-practices history (SPH) skills, knowledge about STDs and HIV infection and preventive counseling advice. The currently funded project has documented project feasibility through a pilot of the survey and a field test of all educational materials. The full scale survey is underway. By the end of the current project, the pre-intervention interview of all physicians will be completed and the intervention begun. This proposal will permit completion of the intervention and evaluation of its impact. A quasi-experimental pre- post-intervention design will be used. Physicians will be randomly assigned to receive mailed written and audio materials (low intervention), mailed material plus a simulated patient and feedback for continuing medical education (CME) credit (high intervention), or no material (control group). Baseline, and short- and long-term data will be collected through telephone interviews with physicians. A 1 month post-intervention interview will more confidently attribute pre-post changes to the intervention, a 6-month post test will detect long-term change in STD/HIV knowledge, SPH and prevention skills. At 7 months post-intervention, a simulated patient evaluator visit, made to ten percent of the study group, will directly observe and thus validate physicians' self-reported SPH assessment and counseling skills. The overall aims of this study are to : document and analyze hypotheses about Washington, D.C. metropolitan area primary care physicians' knowledge, attitudes, and STD/HIV prevention practices at 3 points i time; evaluate the short and long-term effects of a stepped educational intervention on improving physicians' knowledge, SPH and preventive counseling skills regarding STDs/HIV infection among adult patients; estimate the feasibility, costs, and replicability of a simulated patient instructor as an office-based CME method and as a method of validating data; and conduct subgroup analyses to identify ways to extend the office-base CME """"""""STD/HIV prevention"""""""" intervention and evaluation concept.
