O5-S1.06 STD clinic triage based on computer-assisted self interview: the king county experience

Abstract

a short survey capturing demographics, social media use and interest in future testing. Results The advertisement received 401 732 impressions" (displays of the advertisement to users). Nearly all 98%) impressions were to 19e24-year-olds. The daily impressions varied enormously, from 0 to more than 100 000. In the first week, although the advertisement received up to 2,900 daily impressions, no one clicked it. We gradually increased our "bid per click"dthe amount we agreed to pay Facebook for each clickdfrom $0.62 to $0.90. We also modified the advertisement format to depict a college student and to clearly specify the $25 cost of the test. Following these changes, both the number of impressions and "clicks" rose dramatically. Seventy-five individuals clicked the advertisement (25 women and 50 men), with an average cost per click of $0.84. Three students, all female, came for chlamydia testing; one tested positive. Among surveyed individuals (n¼60), 75% reported using Facebook daily or more often. Few (10%) reported ever clicking on Facebook advertisements. Only one surveyed student noticed our Facebook advertisement. The direct-to-laboratory testing concept was popular, with 75% reporting willingness to use this service in the future. Conclusions In this short pilot study, 75 individuals clicked on a Facebook advertisement about chlamydia testing, three came for testing and one tested positive. Facebook advertisements are inexpensive, with high exposure to the target population. A small increase in bid per click can make a very large difference in total impressions. The format of the advertisement is critical for catching the attention of the target audience, because many students report never noticing or clicking Facebook advertisements. Background Computer assisted self interviewing (CASI) has been used at the Melbourne Sexual Health Centre (MSHC) in Victoria, Australia since June 2008, to obtain a pre-consultation sexual risk history. We aimed to evaluate the impact of CASI on consultation times, STI testing rates, patient response rates to CASI questions, and obtain patient and clinician views on CASI. Methods The proportion of patients who declined to answer questions using CASI since 2008 was calculated. We then used the same 12 week period (Feb to May) over three years (2008 pre-CASI), (2009 CASI period), and (2010 non-CASI period-due to a computer theft) to assess consultation times and STI-testing rates. We carried out surveys of clinicians and patients to determine their experience and the acceptability of CASI as part of routine clinical practice. Results 14 190 patients completed CASI during the audit period. Men were more likely than women to decline questions about the number of partners they had of the opposite sex (4.4% v 3.6%, p¼0.05) and same sex (8.9% v 0%, p<0.01). One third (34%) of HIVpositive men did not answer questions on number of partners and 18% declined questions about condom use with insertive anal sex. There was no difference in the mean consultation times during CASI and non-CAS...

New Human Immunodeficiency Virus Diagnosis Independently Associated With Rectal Gonorrhea and Chlamydia in Men Who Have Sex With Men

“…We also used two different methods for obtaining sexual behavior data over the study period – clinician collected and CASI. Although previous analyses have found negligible differences in these methods,(10, 11) it is possible that some bias exists by time period. However, this bias would have affected both cases and controls evenly and thus not affect the results (i.e.…”

“…(Previous analyses have shown the differences in ascertainment of sexual behavior data between these two methods to be negligible. )(10, 11) We used this data to create four mutually exclusive categories of sexual behavior in the prior 12 months: (1) no receptive anal intercourse (RAI); (2) condoms for all RAI regardless of partner HIV status; (3) condomless RAI (CRAI) only with HIV-negative partners; and (4) CRAI with HIV-positive or unknown status partners.…”

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

“…The PHSKC STD Clinic implemented systematic computer-assisted self-interview (CASI) assessments for collecting patient history and developed a computerized algorithm to automate triage in 2010. 15 However, due to the staffing model in place, almost all patients continued to receive a clinician evaluation irrespective of triage status. 12 Therefore, the clinic database contains both CASI responses and outcomes of a clinician evaluation for each patient over a 5-year period.…”

Modernizing Operations to Improve Efficiency and Refine the Role and Mission of Sexually Transmitted Infection Clinics

“…Over the last several years, a rapidly expanding literature has described a variety of testing-focused “express” visit models in STI clinics. These models typically involve triaging asymptomatic patients to a lower cost, less time-intensive clinical service, 3–7 and have often been aided by technological innovations, such as computer-assisted self-registration, 8 computer-assisted self-interview to collect medical history, 7, 9–11 and internet-based provision of testing results. 12 Such innovations are designed primarily to increase efficiency, but also have the capacity to improve the quality of care, for example by using electronic health record data to promote indicated testing and treatment and to diminish the use of services with minimal or no personal or public health impact.…”