Comparison of Algorithms to Triage Patients to Express Care in a Sexually Transmitted Disease Clinic

Chambers, Laura C; Manhart, Lisa E.; Katz, David A.; Golden, Matthew R.; Barbee, Lindley A; Dombrowski, Julia C.

doi:10.1097/olq.0000000000000854

Cited by 7 publications

(5 citation statements)

References 20 publications

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“…With typically constrained resources, STI clinics must provide their services in the most cost‐efficient manner. Non‐invasive NAATs for the diagnosis of gonorrhoea and chlamydia allow the triage of patients into those that need full examination versus those who need only screening: so‐called “express visits,” which has significantly increased efficiency and lowered costs for STI clinics . The “express visit” model has now been widely adopted and has even led to the emergence of stand‐alone express clinics, for example, Dean Street Express in London .…”

Section: Discussion: Improving Sti Servicesmentioning

confidence: 99%

Improving care for sexually transmitted infections

Rietmeijer

2019

J Intern AIDS Soc

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Introduction Rising rates of reported sexually transmitted infections (STIs) in the US and Europe are a public health priority and require a public health response. The diagnosis and treatment of STIs have been the cornerstone of STI control and prevention for many decades and, historically, publicly funded STI clinics have played a central role in the provision of STI care. Innovations in non‐invasive diagnostic techniques, especially nucleic acid amplification tests in the mid‐1990s, have facilitated the expansion of STI testing and treatment outside traditional STI clinics, including primary care, family planning, school‐based health, outreach, corrections, emergency departments and HIV prevention and care settings. As a result, the continued need for categorical STI clinics has been debated. In this Commentary, we discuss how practice can be improved at each level of STI care. Discussion STI practice improvement plans should be tailored to the strengths of each care setting. Thus, in primary care, the focus should be on improving STI screening rates, the provision of hepatitis B and human papillomavirus vaccines and, in jurisdictions where this is legal, expedited partner therapy for gonorrhoea and chlamydia. Extragenital (pharyngeal and rectal) testing for gonorrhoea and chlamydia should be available in settings serving populations more vulnerable to STI acquisition at these anatomical sites, including men who have sex with men. In family planning settings with a mostly female patient population, there are opportunities to serve male partners with both contraceptive and STI services. STI screening rates can also be improved in other settings serving populations at increased risk for STIs, including school‐based clinics, emergency departments, correctional health facilities and providers of HIV care and prevention. These improvements are predominantly logistical in nature and not dependent on extensive STI clinical expertise. While some providers in these settings may have the clinical knowledge and skills to evaluate symptomatic patients, many do not, and STI speciality clinics must be available for consultation and referral and evolve from “safety net” providers of last resort to STI centres of excellence. Conclusions A tailored practice improvement plan can be envisioned to achieve an optimally functioning STI care continuum.

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Section: Discussion: Improving Sti Servicesmentioning

confidence: 99%

Improving care for sexually transmitted infections

Rietmeijer

2019

J Intern AIDS Soc

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“…Finally, a recent review by the what works centre for wellbeing (Chambers et al, 2018) We will include all study designs where a comparison group was used. This includes RCTs, quasiexperimental designs, matched comparisons and other study designs that attempt to isolate the impact of the intervention on homelessness using appropriate statistical modelling techniques.…”

Section: Differences In Analytic Methodsmentioning

confidence: 99%

“…Finally, a recent review by the what works centre for wellbeing (Chambers et al, 2018 ) included 90 studies which included clusters of HF ( n = 47), supported housing ( n = 12), recovery housing ( n = 10), housing interventions for ex‐prisoners ( n = 7), housing interventions for vulnerable youth ( n = 3) and “other” complex interventions targeted at those with poor mental health ( n = 11). Authors presented a comprehensive search strategy of both commercial and grey literature, however, due to resource constraints were unable to conduct independent screening of the potential studies and therefore risk selection bias in the review.…”

Section: Introductionmentioning

confidence: 99%

PROTOCOL: Accommodation‐based interventions for individuals experiencing, or at risk of experiencing, homelessness

Keenan

Miller

Hanratty

et al. 2020

Campbell Systematic Reviews

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Homelessness affects individuals who are experiencing life without safe, adequate or stable housing. Conceived in this way, homeless not only describes those individuals who are visibly homeless and living on the street, but also those precariously housed individuals who; stay in emergency accommodation, sleep in crowded or inadequate housing, and those who are not safe in their living environment. Kuhn and Culhane (1998) further classify individuals experiencing homelessness as those who are chronically homeless, those who are transitionally homeless and those who experience episodic bouts of homelessness. There are causal relationships between various situational and personal factors which lead to an individual experiencing homelessness (Anderson & Christian, 2003; Morse, 1992). Most researchers do agree that important factors include (but are not limited to); a lack of affordable and adequate housing, poverty caused by unemployment or lack of available resources, absence or reduction of health and social services, breakdowns of personal relationships (Crisis, 2020). Global data suggests that at least 1.6 billion people lack adequate housing (Habitat for Humanity, 2017). In the European context this figure continues to rise across all European Union member states with the exception of Finland where homelessness has been on the decline since 1987 (FEANTSA 2017; Y-Foundation, 2017). Without access to housing, individuals are exposed to disease, poverty, isolation, mental health issues, prejudice and discrimination, and are under constant and significant threat to their personal safety. Therefore, having access to safe, stable and adequate housing is internationally recognised as a basic human right (OHCHR, 2009) and is central to developing a population who are living healthy, safe and happy lives. Individuals who are currently experiencing poorer physical and mental health are overrepresented in the homeless population (Link, 2014). Additionally, for the large population who are currently living without homes they continue to suffer due to social inequalities which are persistent and enduring and continue to widen over time. These social inequalities coupled with poor health make the pathways out of homelessness especially challenging. Some of these obstacles include; inability to hold steady employment (Rosenberg & Kim, 2018), encountering prejudice and discrimination while trying to access services (Ramsay, Hossain, Moore, Milo, & Brown, 2019), and addiction issues (Tsemberis, 2011).

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“…A recent review by the What Works Centre for Wellbeing (Chambers et al, 2018 ) included 90 studies which included clusters of Housing First ( n = 47), supported housing ( n = 12), recovery housing ( n = 10), housing interventions for ex‐prisoners ( n = 7), housing interventions for vulnerable youth ( n = 3) and “other” complex interventions targeted at those with poor mental health ( n = 11). Authors presented a comprehensive search strategy of both commercial and grey literature, however, due to resource constraints were unable to conduct independent screening of the potential studies and therefore risk selection bias in the review.…”

Section: Introductionmentioning

confidence: 99%

Accommodation‐based interventions for individuals experiencing, or at risk of experiencing, homelessness

Keenan

Miller

Hanratty

et al. 2021

Campbell Systematic Reviews

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Background: Globally, almost 1.6 billion individuals lack adequate housing. Many accommodation-based approaches have evolved across the globe to incorporate additional support and services beyond delivery of housing.Objectives: This review examines the effectiveness of accommodation-based approaches on outcomes including housing stability, health, employment, crime, wellbeing, and cost for individuals experiencing or at risk of experiencing homelessness.Search Methods: The systematic review is based on evidence already identified in two existing EGMs commissioned by the Centre for Homelessness Impact (CHI) and built by White et al. The maps were constructed using a comprehensive three stage search and mapping process. Stage one mapped included studies in an existing systematic review on homelessness, stage two was an extensive search of 17 academic databases, three EGM databases, and eight systematic review databases. Finally stage three included web searches for grey literature, scanning reference lists of included studies and consultation with experts to identify additional literature. We identified 223 unique studies across 551 articles from the effectiveness map on 12th April 2019.Selection Criteria: We include research on all individuals currently experiencing, or at risk of experiencing homelessness irrespective of age or gender, in high-income countries. The Network Meta-Analysis (NMA) contains all study designs where a comparison group was used. This includes randomised controlled trials (RCTs), quasi-experimental designs, matched comparisons and other study designs that attempt to isolate the impact of the intervention on homelessness. The NMA primarily addresses how interventions can reduce homelessness and increase housing stability for those individuals experiencing, or at risk of experiencing, homelessness. Additional outcomes are examined and narratively described. These include: access to mainstream healthcare; crime and justice; employment and income; capabilities and wellbeing; and cost of intervention. These outcomes reflect the domains used in the EGM, with the addition of cost.

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Comparison of Algorithms to Triage Patients to Express Care in a Sexually Transmitted Disease Clinic

Abstract: The overall performance of the statistically optimized algorithm did not differ meaningfully from a simple 2-component algorithm. In contrast, the current algorithm had the highest sensitivity but lowest overall performance.

Cited by 7 publications

References 20 publications

Improving care for sexually transmitted infections

Improving care for sexually transmitted infections

PROTOCOL: Accommodation‐based interventions for individuals experiencing, or at risk of experiencing, homelessness

Accommodation‐based interventions for individuals experiencing, or at risk of experiencing, homelessness

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