Patient-initiated delay at a genitourinary medicine clinic: are there public health consequences?

Sanmani, Leela; Foley, Elizabeth; Samraj, S; Rowen, D; Yadegarfar, Ghasem; Patel, Raj

doi:10.1136/sti.2008.032425

Cited by 4 publications

(4 citation statements)

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“…In genitourinary (GU) medicine clinics, DNAs may also pose a potential public health risk through the onward transmission of any untreated sexually transmitted infections (STIs). 1–3 In 2006, the UK Department of Health (DH) determined that all patients requesting a GU medicine appointment should be offered such an appointment within 48 hours, and 95% of all patients should be seen within this time. 4,5 Nationally, GU medicine clinics are ‘open access’: booking is unrestricted, and ‘walk-in’ services are offered for those unable or unwilling to attend a clinic appointment.…”

Section: Introductionmentioning

confidence: 99%

Do ‘do not attends’ at a genitourinary medicine service matter?

et al. 2010

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Patients who do not attend (DNA) clinic appointments are wasteful of resources and may also pose a potential public health risk through the onward transmission of untreated sexually transmitted infections (STIs). This service evaluation was performed to assess the demographics of DNAs, patient reasons for non-attendance and follows up data to determine the health outcomes of non-attendance. The genitourinary (GU) medicine clinic DNA rate between October 2008 and March 2009 was 6% (383/6961). Of the 383 patients who DNA'd their appointment successful telephone contact was made in 182 (48%) of them. Of these 40% of patients reported that they had forgotten they held an appointment; no patients reported that clinic opening hours prevented their attendance. Telephone contact increased GU medicine clinic attendance by 9% (35/383), but led to a greater number of subsequent DNAs; 43/75 (63%) of patients who accepted a further appointment DNA'd that appointment. Sending a SMS text message to patients who DNA notifying them of the time of walk-in services might be the most effective way of recapturing these patients without compromising future clinic appointment slots.

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Section: Introductionmentioning

confidence: 99%

Do ‘do not attends’ at a genitourinary medicine service matter?

et al. 2010

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“…The article by Sanmani et al in this issue ( see page ) adds to the debate by suggesting that the 95% target of patients seen in <48 h is too restrictive 7. Using the precise DH definition, which is that patients should be seen within 2 working days, 8% of their patients seen in the clinic in a 3 month period fell outside of this target access time through personal choice and in reality 10% were seen >48 h if weekends were included.…”

mentioning

confidence: 99%

Do all patients wanting a sexually transmitted infection screen need to be seen within 48 hours?

Brook

2008

Sexually Transmitted Infections

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“…A total of 4.2% of the sample reported unprotected sex with at least one new partner since symptoms had begun. A retrospective review of GUM clinic case notes by Sanmani et al (2008), also in the UK, found that none of the symptomatic patients in their study reported unprotected sex with a new partner after booking their appointment, although it is possible that social desirability bias (the tendency of respondents to answer questions in a manner that will be viewed favourably by others) may have influenced results in this study.…”

Section: Time To Presentationmentioning

confidence: 73%

Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand: A mixed methods study

Denison

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<p>Sexually transmitted infections (STIs) are a global public health problem. Sequelae for infected individuals can be serious and STIs impose a substantial financial burden on healthcare systems. Duration of infection is one factor influencing transmission rates, and is modifiable through secondary prevention methods, namely ‘test and treat’. For this approach to be effective, at-risk individuals must choose to present for testing. New Zealand provides a useful case-study to investigate healthcare-seeking behaviour for STI testing, as incidence rates of common STIs are especially high. The aims of this thesis were to quantify healthcare-seeking behaviour for STI symptoms and assess the risk of transmission in this period, to identify the barriers to STI testing, to understand the personal drivers for getting an STI test, to examine how STI knowledge is associated with testing behaviour, and finally, to collate and critically evaluate the published evidence regarding the incidence of a lesser known sequela of STI, reactive arthritis. This thesis took a mixed method approach, employing both qualitative and quantitative methods to address the research aims. The results showed that delays in healthcare-seeking for STI symptoms were common among patients attending an inner-city Sexual Health Clinic (SHC). Almost half of people with symptoms waited longer than seven days to seek healthcare, although there were no identified predictors of delayed healthcare-seeking. Around a third of people with symptoms continued to have sex after they first thought they may need to seek healthcare. Among these individuals, infrequent condom use was reported more by those who had sex with existing sexual partners than by those who had sex with new partners. Having sex while symptomatic was statistically significantly associated with delaying seeking healthcare for more than seven days (odds ratio (OR) = 3.25, 95% CI 1.225 – 8.623, p = 0.018). Analysis of qualitative interview data revealed three types of barriers to testing. These were personal (underestimating risk, perceiving STIs as not serious, fear of invasive procedure, self-consciousness in genital examination and being too busy), structural (financial cost of test and clinician attributes and attitude) and social (concern of being stigmatised). This work also revealed several drivers for testing including crisis, partners, clinicians, routines, and previous knowledge. Knowledge of the incidence, asymptomatic nature and sequelae of STIs featured prominently in the explanations of those who undertook routine testing. However, at the same time, many of the participants felt they did not have a good knowledge base and that their school-based sex education had been lacking. STI knowledge was investigated further using quantitative methodology. Levels of STI knowledge were generally good and did not differ between a Student Health Service population and an SHC population. Individuals who had tested before had significantly better knowledge than those who were attending for testing for the first time (U = 10089.500, Z = -4.684, p < 0.001). In addition, total knowledge score was an independent predictor of having had a previous test (OR = 1.436, 95% CI 1.217-1.694, p < 0.001). Reactive arthritis can be triggered by STI, thus STI screening patients who present with reactive arthritis has the potential to identify undiagnosed infection. This thesis provides the first assessment of the international literature regarding the incidence of reactive arthritis after STI. The systematic review found only three published studies which had prospectively examined the incidence of reactive arthritis after STI. The studies reported an incidence of reactive arthritis after STI of 3.0% to 8.1% and were found to be of low to moderate quality. In conclusion, this thesis provides healthcare service providers, policy makers and clinicians with data to inform practice and public health interventions aimed at improving healthcare-seeking behaviour for STI testing. It illustrates that delayed healthcare-seeking for STI symptoms is a common behaviour in New Zealand and could potentially be contributing to STI transmission and downstream burden on the health system. This work provides evidence of the drivers of STI testing that can be promoted, and the barriers that need to be removed. Specifically, improving STI knowledge may positively impact on testing rates. Lastly, this research indicates that there is a need for more studies assessing the incidence of reactive arthritis after an STI.</p>

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Patient-initiated delay at a genitourinary medicine clinic: are there public health consequences?

Abstract: Despite 10% of patients choosing to delay attendance beyond 48 h, no adverse public health outcomes were demonstrated.

Cited by 4 publications

References 8 publications

Do ‘do not attends’ at a genitourinary medicine service matter?

Do ‘do not attends’ at a genitourinary medicine service matter?

Do all patients wanting a sexually transmitted infection screen need to be seen within 48 hours?

Healthcare-seeking behaviour for sexually transmitted infection testing in New Zealand: A mixed methods study

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