Streptococcal sore throat followup program in a hospital clinic, New York City

To improve followup and treatment of patients with streptococcal sore throat at St. Vincent's Hospital and Medical Center, New York City, a simple and inexpensive method was devised for recalling and treating untreated patients with positive throat cultures and culturing household contacts. The program was conducted by a clinic nurse and a secretary, with only occasional assistance from a physician. All services were free for those without Medicaid coverage. The secretary sent notification letters to all patients with positive cultures urging them to return for treatment and emphasizing the need for their contacts to come for screening. The secretary, trained in the throat culturing technique, also performed the laboratory work on the cultures from contacts. The clinic nurse swabbed the throats of all contacts and administered treatment, according to a standing-order protocol, to all with culture-proved streptococcal sore throat. A comparison of initially untreated patients with positive cultures seen 3 months before and 6 months after the program was started revealed that 46 percent returned for treatment after the notification letter was sent; before the program only 21 percent returned for treatment. No attempt had been made to reach household contacts before the program began. The rate of streptococcal sore throat in contacts was 14 percent, and in the clinic patients it was 11 percent during the first 6 months of the program.