Computerized Self-Interviews Improve Chlamydia and Gonorrhea Testing Among Youth in the Emergency Department

Abstract

Study Objective National guidelines recommend annual Chlamydia trachomatis and Neisseria gonorrhea screening for sexually active youth at-risk for infection. These infections have serious sequelae in women if untreated, and methods to improve testing are needed. We hypothesized that an electronic method of identifying at-risk youth would significantly increase testing for these sexually transmitted infections during emergency department (ED) visits. Methods We developed an audio-enhanced computer-assisted self-interview (ACASI) to obtain sexual histories from ED patients and an embedded decision-tree to create an STI testing recommendation. ED healthcare providers were prompted via the electronic medical record to review the participant answers and testing recommendations, and to offer testing to at-risk youth. Patients 15-21 years old visiting the St. Louis Children's Hospital ED, regardless of complaint, were eligible for participation. Results STI testing among all 15-21 year old ED patients increased from 9.3% in the three months prior to the ACASI, to 17.8% during the eight-month period the ACASI was available, and diminished to 12.4% in the three months after ACASI withdrawal (P<0.001). During the ACASI period we approached 51.4% of eligible patients and enrolled 59.8% (800/1337) of those approached. Among ACASI participants, 52.4% (419/800) received a recommendation to receive STI testing. Of these, 52.7% (221/419) received testing in the ED, and 18.1% (40/221) of those tested were positive for chlamydia and/or gonorrhea, 55% of whom (22/40) had chief complaints unrelated to STIs. Most (89%) participants rated the ACASI easy to use. Conclusions STI testing in the ED significantly increased during ACASI use and diminished after withdrawal. The ACASI was well accepted by youth and holds promise for enhancing STI testing in the ED.

Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department

“…We previously reported that the ACASI identified >50% of participants as needing STI testing, and this resulted in an increase in STI testing among adolescents in our ED 19. To our knowledge, the current study is the first to both capture a sexual history via an ACASI and determine patients’ willingness to receive STI testing in the ED regardless of ED chief complaint.…”

“…Our participants reported they preferred this mode of disclosure to face-to-face interviews,19 offering options for its application even in patients whose complaints do not relate to STIs 15–18 23 24. Potential barriers to gathering sexual history information in the ED might include lack of time or the limited privacy in the ED environment.…”

“…As described previously,19 we tested the ACASI in the ED of an urban, tertiary care, free-standing children’s hospital, which treats approximately 50 000 patients annually, serving many youth from a Metropolitan Service Area with a high STI prevalence 1 20. Following institutional review board approval at Washington University School of Medicine, participants reported demographic and sexual-behaviour information using an ACASI delivered on a laptop computer.…”

“…An integrated software program created a recommendation for STI testing based on each participant’s responses and CDC testing recommendations. The ACASI questions and the decision tree used to determine testing recommendations are published 19. We developed questions in collaboration with experts in paediatric emergency medicine, adolescent medicine, health behaviour research and paediatric infectious disease.…”

“…We previously described how we developed an ACASI to obtain a sexual history from adolescent/young adult patients in the ED and how it was used to increase gonorrhoea and chlamydia screening and testing in a paediatric ED setting 19. The purpose of this paper was to examine associations among demographics, sexual behaviour, chief complaint and willingness to be tested.…”