Evaluation of an Automated Express Care Triage Model to Identify Clinically Relevant Cases 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.0000000000000643

Cited by 8 publications

(11 citation statements)

References 16 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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“…STI clinics have used a variety of tools for their "express" testing intake process, including kiosks, tablets (that use computer-assisted self-interviewing), and paper forms reviewed by a staff member (ie, nurse, health educator, etc.). [27][28] Student health centers should select an intake format that best fits with their clinic structure while keeping in mind that many students are not comfortable with an "in person" process. Furthermore, individuals identified as ineligible for self-collection STI testing services through the intake process should be notified of their ineligibility and encouraged to schedule an appointment with a health care provider; while eligible individuals should be directed to complete a behavioral risk assessment (again using the kiosk, tablet, or paper form).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, individuals identified as ineligible for self-collection STI testing services through the intake process should be notified of their ineligibility and encouraged to schedule an appointment with a health care provider; while eligible individuals should be directed to complete a behavioral risk assessment (again using the kiosk, tablet, or paper form). [27][28] Results from behavioral risk assessments could be used to determine which collection methods (eg, oral, vaginal, rectal swabs, or urine tests) should be included in students' selftesting kits. Students could pick up their test kit from the student health center (preferably in a convenient and/or private location), go into a private room (or take the test kit home), test themselves, and return their completed test kit (again, in a convenient and/or private location).…”

Section: Discussionmentioning

confidence: 99%

College students’ comfort with and intention to use self-collection services for STI testing

Lindley

Sharif

Chowdhury

2020

Journal of American College Health

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Objective: Sexually transmitted infections (STIs) are at unprecedented levels; yet most college students have never been tested. Offering asymptomatic individuals the option to collect their own samples for STI testing is an effective strategy to increase testing coverage. This study explores students' perceptions of self-collection services. Participants: Four hundred and thirty-four (434) students from a large public university completed an online survey in February 2018. Methods: The cross-sectional survey assessed students' human immunodeficiency virus (HIV)/STI testing behaviors, comfort with self-collection procedures, and intention to use self-collection services if offered on campus. Results: Most students (88%) said they would use self-collection test kits they could take home, followed by self-collection in a private room at student health services (59%). Students were most comfortable with testing procedures involving less human interaction and collecting specimens themselves. Cost, accuracy, confidentiality of tests, and provision of clear "how to" instructions, topped students' concerns. Conclusion: Offering self-collection options may increase STI testing among asymptomatic college students.

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“…Using self-reported data on recent sexual behaviours, service users could be directed to different interventions, including postal self-testing, or face-to-face appointments in a SHC. Service user self-triage has been shown to be feasible and reliable in other settings 22…”

Section: Discussionmentioning

confidence: 99%

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

Roy

King²,

Gilson

et al. 2019

Sex Transm Infect

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ObjectiveBehavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage individuals to these services.MethodsWe conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes.ResultsWe conducted 35 service user (15 heterosexual young people; 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users.ConclusionOverall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services.

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Evaluation of an Automated Express Care Triage Model to Identify Clinically Relevant Cases in a Sexually Transmitted Disease Clinic

Abstract: The CASI-based algorithm accurately identified patients who were eligible for express care based on a disease-focused outcome.

Cited by 8 publications

References 16 publications

Improving care for sexually transmitted infections

Improving care for sexually transmitted infections

College students’ comfort with and intention to use self-collection services for STI testing

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

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