Use of computerized medical records to determine the feasibility of testing for chlamydia without patients seeing a practitioner

Abstract

The proportion of clinically important diagnoses in a low-risk, asymptomatic population who use a computer-assisted self-interview (CASI) to assess risk was needed to determine optimal health service delivery. Medical records were retrospectively analysed between July 2008 and June 2009 for risk characteristics and diagnoses. A total of 7733 new patients completed a CASI, of whom 1060 were asymptomatic heterosexuals. From this low-risk group, 26 diagnoses were made on the day of presentation, including 22 cases of genital warts (2.08% [95% confidence interval (CI) 1.22-2.93]), three cases of genital herpes (0.28% [95% CI 0.055-0.82]) and one case of unintended pregnancy (0.094% [95% CI 0.0061-0.52]). Additionally, there were 54 cases of chlamydia detected (5.09% [95% CI 3.77-6.42]). As chlamydia is effectively diagnosed and managed from self-collected samples, patient review is not always required. This study provides evidence for an express testing service for chlamydia to streamline the screening of low-risk, asymptomatic heterosexual patients as identified by CASI without the need to for a traditional face-to-face consultation.

Computer Assisted Self Interviewing in a Sexual Health Clinic as Part of Routine Clinical Care; Impact on Service and Patient and Clinician Views

“…These findings from a large evaluation, in addition to the smaller analytical studies generally support the introduction of CASI into clinical STI services [5]–[9]. The true value of CASI is most likely to be realized when it is integrated with further innovations in clinical care such as the development of express clinical services, although CASI operating alone allows for the development of a detailed behavioral surveillance system [12], [13].…”

Systematic selection of screening participants by risk score in a chlamydia screening programme is feasible and effective

“…A web-based ‘eTriage’ tool was used for triage and booking appointments in genitourinary medicine clinics in London 26. Risk and symptom self-assessment was used as a way to select male patients visiting a sexual health clinic in the UK,27 and computer-assisted self-interviews for sexual history taking have been shown to be reliable, efficient and highly acceptable in clinical sexual health settings28 29 and general practices30 in Australia. We think such a selection tool in the setting of an online accessible STI testing website can be very helpful to facilitate case detection and treatment within the target group of young people, who tend to use the internet for private medical matters frequently already.…”