Presenting to the Emergency Department Versus Clinic-Based Sexually Transmitted Disease Care Locations for Testing for Chlamydia and Gonorrhea: A Spatial Exploration

Abstract

Background Rates of sexually transmitted diseases (STDs) including chlamydia and gonorrhea are increasing in the United States while public health funding for STD services is decreasing. Individuals seek care in various locations including the emergency department (ED). The objective of this study is to investigate whether there are more physically proximal clinic-based STD care locations available to individuals who present to the ED in a major metropolitan area. Methods Addresses of EDs, clinics, and patients 13 years or older in St. Louis City or County given a nucleic acid amplification test and assigned an STD diagnosis (n = 6100) were geocoded. R was used to analyze clinics within 5 radii from the patients' home address and assess missed clinic opportunities (open, no charge, with walk-in availability) for those living in an urban versus suburban area. Results In urban areas, 99.1% of individuals lived closer to a clinic than the ED where they sought STD services; in suburban areas, 82.2% lived closer to a clinic than the ED where they presented. In the region, 50.6% lived closer to the health department-based STD care location than the hospital where they presented. Up to a third of ED patient visits for STD care could have occurred at a clinic that was closer to the patient's home address, open, no charge, and available for walk-in appointments. Conclusions Clinic availability is present for most of the individuals in our study. Clinics providing STD services can increase advertising efforts to increase public awareness of the services which they provide.

Ten-Year Trend in Emergency Department Visits for Sexually Transmitted Infections among Adolescents: A Retrospective Cross-Sectional Study in Italy

“…In particular, specialized centers offer sex education, follow up the patients and provide dedicated services for testing and treatment, which are not always available elsewhere. On the other hand, coherently with other studies, EDs in addition, even if less well-equipped for STIs, are frequently selected as suitable venues for STIs’ care [ 21 ]. This could happen because citizens are unaware of characteristic symptoms or the availability of STI specialized services, or they may inappropriately prefer the ED as a direct access point, especially in situations of perceived urgency, as EDs have no time restrictions and may be closer to the patient’s home [ 22 , 23 , 24 ].…”

Trends in Chlamydia and Gonorrhea Testing and Positivity Rates in a Safety Net Hospital in Georgia: 2014 to 2017

“…Reasons for the increased utilization of emergency services for STI care include more convenient locations and hours, anonymity to avoid the stigma of seeking STI care, and presumptions of lower cost and guaranteed treatment for patients who are uninsured. 11,18 Second, testing in infectious diseases also drove NAAT volume growth. In 2015, the CDC issued guidance for frequent (every 3-6 months) CT/GC genital and extragenital screening in MSM.…”

“…In our sample, approximately 95% of the population identifies as non-White, and more than one-third are covered through Medicare/Medicaid programs. Reasons for the increased utilization of emergency services for STI care include more convenient locations and hours, anonymity to avoid the stigma of seeking STI care, and presumptions of lower cost and guaranteed treatment for patients who are uninsured 11,18 . Second, testing in infectious diseases also drove NAAT volume growth.…”

Who Is Practicing Expedited Partner Therapy and Why? Insights From Providers Working in Specialties With High Volumes of Sexually Transmitted Infections

“…The ED at GHS performs more CT testing than all primary care specialties combined, yet no EM interviewees offered EPT. Although EPT may be useful for partners of patients who use EDs for STI care, one respondent expressed concern that increasing STI-related services in the ED, through the implementation of POCT and EPT, might inadvertently encourage more patients to use EDs for STI care in what is an already overburdened system 23 . One OB/GYN provider felt that EPT was only a “temporary solution” because the male partner receives care without engaging with the health care system, perpetuating the disparities between men and women’s care 24 .…”

“…Although EPT may be useful for partners of patients who use EDs for STI care, one respondent expressed concern that increasing STI-related services in the ED, through the implementation of POCT and EPT, might inadvertently encourage more patients to use EDs for STI care in what is an already overburdened system. 23 One OB/GYN provider felt that EPTwas only a "temporary solution" because the male partner receives care without engaging with the health care system, perpetuating the disparities between men and women's care. 24 Although no literature could be found to show that POCT and EPT increase ED utilization, there is ample evidence that partner management strategies increase PN, which can lead to partner testing in a health care center.…”