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Incorporating Male Services into Clinical Practice

Incorporating Male Services into Clinical Practice. Iris Stendig-Raskin MSN, CRNP, WHNP-BC Clinician/Consultant. Objectives. Identify key points that should be considered when discussing comprehensive male health care .

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Incorporating Male Services into Clinical Practice

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  1. Incorporating Male Services into Clinical Practice Iris Stendig-Raskin MSN, CRNP, WHNP-BC Clinician/Consultant

  2. Objectives • Identify key points that should be considered when discussing comprehensive male health care. • Explore how best practices can be integrated into the family planning setting. • Identify barriers to care and how they affect our male clients. • Identify community referral resources.

  3. Silent Health Crisis “There is a silent health crisis in America..it’s that fact that, on average, American men live sicker and die younger than American women.” Dr. David Gremillion Men’s Health Network

  4. Men’s Health as a Family Issue “Recognizing and preventing Men’s health problems is not just a men’s issue…. Because of it’s impact on wives, mothers, daughter’s,and sisters, men’s health is truly a family issue.” Representative Bill Richardson (NM) Congressional Record , May 24,1994 Passage of National Men’s Health Week www.men’shealthnetwork.org

  5. Men’s Health as a Family Issue • 115 Males are conceived for every 100 females • By age 36, women outnumber men • By age 100, women outnumber men 8:1 • Of more than 9 million older persons living alone, 80% are women • More than ½ of the elderly widows now living in poverty were not poor before the deaths of their husbands. The New York Times 2003 US Administration on Aging. www.men’shealthnetwork.org

  6. Silent Health Crisis Statistics • Life Expectancy Gender Gap: • 1920: gender gap was 1.0 year • 2004 : men dying 5.2 years sooner than women • Life expectancy by Sex: • Men: 75.2 • Women: 80.4 National Center for Health Statistics (NCHS). 2004 data.released April 2006.Vol. 48; #18

  7. Silent Health Crisis Statistics • Almost twice as many men(108.9) than women die from heart disease (55.6) • Men as victims of homicide: • 1:30 Afro-American males • 1:132 Afro-American females • 1:179 Caucasian males • 1:495 Caucasian females www.menshealthnetwork.org

  8. Silent Health Crisis Statistics • Depression and Suicide • Depression in men is undiagnosed contributing to the fact that men are 4x as likely to commit suicide. (Women attempt 3x > men) • Among 15-19 year olds: • Boys were 5x as likely to commit suicide than girls • Among 20-24 year olds: • Males were 7x as likely to commit suicide than females • Suicide rate for individuals over 65 years of age: • Men 38.4….Women 6.0 www. Menshealthnetwork.org

  9. “The Weaker Sex” • 25% more newborn males die than females • SIDS is 1.5 x as common in boys than girls • Boys are 3-4 x as likely to be autistic • Boys are 3x as likely to have Tourette’s Syndrome • Dyslexia is diagnosed 2-3 x as often in boys than girls • Men have fewer infection fighting T cells and are thought to have a weaker immune system than women “The Weaker Sex” Maggie Jones New York Times Magazine. March 15, 2005

  10. Leading Causes of Death:All Men USA: 2006 Cause of Death • Heart Disease 26.3 • Cancer 24.1 • Injuries (unintentional) 6.6 • Chronic lower respiratory disease 4.9 • Stroke 4.5 • Diabetes 3.0 • Suicide 2.2 • Pneumonia/influenza 2.1 • Kidney disease 1.8 • Alzheimer’s Disease 1.8 • http://www.cdc.gov/men/lcod/index.htm. accessed. 2/18/11

  11. Leading Causes of Death:White Males, All Ages: 2006 Cause of Death • Heart Disease 26.6 • Cancer 24.5 • Injuries (unintentional) 6.5 • Chronic lower respiratory disease 5.3 • Stroke 4.4 • Diabetes 2.8 • Suicide 2.3 • Pneumonia/influenza 2.2 • Alzheimer’s Disease 1.9 • Kidney Disease 1.7

  12. Leading Causes of Death:Afro-American Men, All Ages:2006 Cause of Death • Heart Disease 24.4 • Cancer 21.9 • Injuries (unintentional) 6.5 • Homicide 5.2 • Stroke 5.0 • Diabetes 3.9 • HIV Disease 3.0 • Chromic Lower Respiratory Disease 2.8 • Kidney Disease 2.6 • Perinatal Conditions 1.9

  13. Leading Causes of Death:Hispanic Males, All Ages: 2006 Cause of Death • Heart Disease 20.9 • Cancer 18.7 • Injuries (unintentional) 12.3 • Stroke 4.4 • Diabetes 4.2 • Homicide 4.0 • Chromic liver disease 3.4 • Suicide 2.4 • Chronic lower respiratory infections 2.3 • Perinatal Conditions 2.1

  14. Myths about Men’s Health • They don’t care about their health • Can access care whenever they want to • Don’t need regular health care since they have fewer health issues that need monitoring www.agi.com

  15. Realities • Are concerned…and • Often are unable to talk about their concerns until it is too late www.agi.com

  16. Societal awareness of men’s needs will improve Improve information, counseling, and clinical services for both men and women, Men will receive the information and services that they need to protect their health and make true informed choices. Expansion of services Benefits of Addressing Men’s Needs:

  17. Sexual and Reproductive Health Milestones Intend no more children First intercourse First marriage First birth Spermarche MEN 33.2 26.7 14.0 28.5 16.9 AGE 10 15 20 25 30 35 12.6 26.0 17.4 25.1 30.9 WOMEN First birth Menarche First marriage First intercourse Intend No More children

  18. Sexual Activity Is Increasingly Common After Adolescence (among those aged 15-49) % Had intercourse 15-19 20-29 30-39 40-49

  19. Most Men Have Had One Sexual Partner In the Past Year. Multiple Partners are More Common Among Men in Their Teens and 20s Than Among Men of Other Ages No. of partners in past year 15-19 20-29 30-39 40-49

  20. As Men Become Older, They Are More Likely to Be in a Relationship(among those age 20-49) %

  21. Male Methods Account for High Proportions of Contraceptive Use at all Ages % 15-19 20-24 25-29 30-34 35-39

  22. Men in Their 20s Are More Likely to Be Uninsured Than Are Men of Other Ages % 15-19 20-24 25-29 30-39 40-49

  23. Few Men Make Sexual and Reproductive Health Visits Annual visits per 100 men 15-19 20-24 30-34 35-39 40-44 45-54 25-29

  24. Access to Care • Up to 1/3 of men do not visit their PCP on an annual basis: compared to less than 10% of women • Men aged 19-29 are least likely to see a PCP • More men begin to visit their PCP by age 45 but a gap in utilization between men and women continues past age 65 www.agi.som

  25. Accessing Care Issues • Concept of preventive care • Sense of invulnerability • Unfamiliar with medical system • Unfamiliar with medical exam • Need to disclose • Accessing care

  26. Why Don’t Men come for Care? • Perception or reality ????????? • Family planning clinics are female dominated • Men are not as familiar with the health care system as women • Negative attitudes towards male involvement by staff • Negative attitudes towards male involvement by female consumers • Male attitudes toward involvement in family planning • Lack of clinical training on men’s reproductive care issues. Family planning male training center.www.fpmtc.org

  27. Why do Men come to our Centers ? • Testing • Treatment • Coerced to come • Fear

  28. Men: The Forgotten Component of Contraceptive Counseling • Clinicians need to inform sexually active females and partners about • Condoms • Emergency contraception • Vasectomy • STI and HIV/AIDS prevention

  29. Partner Communication Resultsin Better Continuation Rates One-year contraceptive continuation twice as high when partner included in counseling Percentage of couples continuing contraception after 12 months 33% 17% Partnerinvolved incounseling Partner not involved incounseling Terefe A, Larson CP. Modern contraception use in Ethiopia: does involving husbands make a difference? Am J Public Health 1993 Nov;83(11):1567-71. Herndon N. Men influence contraceptive use. Network. 1998 Spring;18(3):13.

  30. Walking through the door…

  31. The Case of MC • MC is a 16 yo male, who had just noticed “bumps down there” He has mustered up enough courage to walk into the health center after making an appointment. • He is greeted with the following: • The receptionist is on the phone; she hands him a packet of forms to fill out and motions him to take him to take a seat • There are 6 other individuals in the room-all women. • There are many health pamphlets available-but all geared to BCM,BSE and vaginitis • He takes a seat and begins to complete the health history form and intake information. • He returns the forms to the receptionist,and is told “that the wait shouldn’t be much longer”. He returns to his seat and begins to flip through “TEEN People” ( the only other magazines available were “Redbook”, “Style” and “Prevention”

  32. The Case of MC • How do you think he is feeling? • What might make him feel more comfortable? • What interventions might the staff want to take?

  33. What is TITLE X? • Established in 1970-broad bi-partisan support • James Scheuer (D-NY) • Joseph Tydings (D-MD) • Charles Percy (R-IL) • George Bush (R-TX) • Mandates to serve both men and women • 1995-first grant awarded re: male research

  34. Title X Program Priorities • “Encouraging participation of families, parents, and/or other adults acting in the role of parents in the decision of minors to seek family planning services….. • “Promoting individual and community health by emphasizing family planning and related preventive health services for heard-to-reach populations, such as uninsured or underinsured individuals, males, persons with limited English proficiency….. • http://www.hhs.gov/opa/familyplanning/index.html

  35. Title X required services for Males • Client Education: • Services must provide clients with the information to: • Use specific methods of contraception and identify adverse effects • Perform testicular self-exam (TSE) • Reduce risk of STI’s and HIV

  36. What are components ofBest Practices….

  37. Information • Basic sexuality and reproductive health education • Genital health and hygiene • Healthy relationships • Pregnancy prevention • Sexually Transmitted Infections • Parenthood • Other Medical services and concerns • Referrals Guidelines for Male Sexual and Reproductive Health Services: MAC: Region 2, Male Involvement Advisory Committee 2009

  38. 3 Categories to Best Practices • Screening • Health Promotion/Education and Counseling • Clinical Diagnosis and Treatment Guidelines for Male Sexual and Reproductive Health Services: MAC: Region 2, Male Involvement Advisory Committee 2009

  39. Screening • Screening: • Sexual and reproductive health • Medical history • Partner history • Sexual experiences • Pregnancy history • STI history

  40. Screening-Continued • Family and peer relationships • Emotional, physical and sexual abuse • Psycho-social matters • Testicular,anal, colorectal and prostate cancer • ATOD

  41. Health Promotion, Education and Counseling • Male and Female anatomy and physiology • Male and Female pubertal changes • Changes over the lifespan • Impact of ATOD on sexual functioning • Family planning and STI awareness • Cancer screening Guidelines for Male Sexual and Reproductive Health Services: MAC: Region 2, Male Involvement Advisory Committee 2009

  42. Counseling • Method counseling must be individualized to client, and include: • Effective use of methods, including NFP, benefit and efficacy of methods • Post-coital contraception • Emergency 24 hour telephone number • Location where emergency services can be obtained • STD and HIV Counseling: • An individualized dialogue with the client where there is discussion of personal risks and the steps to be taken to reduce risks if necessary…..

  43. Clinical Diagnosis and Treatment • Skin Lesions • STI/HIV Screening • Anatomy and Physiology Concerns • Infertility Concerns • Hernias • Varicoceles • Vasectomy • Referrals as Indicated Guidelines for Male Sexual and Reproductive Health Services: MAC: Region 2, Male Involvement Advisory Committee 2009

  44. So-What services does your center offer? • Comprehensive Male exams • Sports physical • Couple counseling regarding contraception • Couple counseling regarding pre-conception and pregnancy • STI testing and treatment • Cancer screening • Appropriate community referrals…

  45. Referrals for…. • Sexuality Concerns • Education/employment/vocational training • Substance Abuse Treatment • Mental Health Concerns • Parenting Classes • Couple Counseling • Urologists/Vasectomy Services • …and the list is endless..AND • Who in your agency is responsible for follow-up???

  46. What gets in the Way? • Barriers…and can we • Overcome them….

  47. Issues that affect Male Involvement in Family Planning (re-cap) • Negative Influencing Factors (perceived or real) • Female dominated Centers • Lack of familiarity with health care setting • Negative attitudes by staff • Negative attitudes towards male clients by female clients • Male attitudes towards involvement in family planning • Lack of clinical training www.region8familyplannin.org/publprod.htm (JSI Research and Training Institute. Denver, Colorado)

  48. Issues that affect Male Involvement in Family Planning • Positive Influencing Factors • Behavioral changes through counseling and education • Changing attitudes regarding contraceptive responsibility • STI’s and HIV screening • Community outreach • Financial Eligibility: ie: Title X www.region8familyplannin.org/publprod.htm (JSI Research and Training Institute. Denver, Colorado)

  49. IS your agency male friendly? • ….and how so????? • Does mission statement reflect needed services? • Separate day for male services? • Male provider? • Special hours?

  50. Atmosphere of center… • Posters and literature: • Male friendly or ‘male bashing?’ • Magazines… • Is there training for staff? • Does your center treat partners? • What are your outreach efforts?

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