Mapping patient pathways and estimating resource use for point of care versus standard testing and treatment of chlamydia and gonorrhoea in genitourinary medicine clinics in the UK.

OBJECTIVES: We aimed to explore patient pathways using a chlamydia/gonorrhoea point-of-care (POC) nucleic acid amplification test (NAAT), and estimate and compare the costs of the proposed POC pathways with the current pathways using standard laboratory-based NAAT testing. DESIGN/PARTICIPANTS: Workshops were conducted with healthcare professionals at four sexual health clinics representing diverse models of care in the UK. They mapped out current pathways that used chlamydia/gonorrhoea tests, and constructed new pathways using a POC NAAT. Healthcare professionals' time was assessed in each pathway. OUTCOME MEASURE: The proposed POC pathways were then priced using a model built in Microsoft Excel, and compared to previously published costs for pathways using standard NAAT-based testing in an off-site laboratory. RESULTS: Pathways using a POC NAAT for asymptomatic and symptomatic patients and chlamydia/gonorrhoea-only tests were shorter and less expensive than most of the current pathways. Notably, we estimate that POC testing as part of a sexual health screen for symptomatic patients, or as stand-alone chlamydia/gonorrhoea testing, could reduce costs per patient by as much as £16 or £6, respectively. In both cases, healthcare professionals' time would be reduced by approximately 10 min per patient. CONCLUSIONS: POC testing for chlamydia/gonorrhoea in a clinical setting may reduce costs and clinician time, and may lead to more appropriate and quicker care for patients. Further study is warranted on how to best implement POC testing in clinics, and on the broader clinical and cost implications of this technology.

'Do it yourself' sexual health care: the user experience.

OBJECTIVES: To describe client experience of self-management within a busy walk-in, sexual health service. Self-management in this context is self-registration and take-home pregnancy tests, chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) tests, or condoms dispensed from a free vending machine. METHODS: Twenty-four in-depth, semi-structured interviews with users; 19 structured written reports from mystery shoppers paid to visit the service and report their experience; demographic details of those using the self-management option from the clinic database and 40 h of recorded observation in the clinic waiting room. RESULTS: Between 2 September 2008 and 1 September 2009, 18 657 people had 28 545 attendances at the service. Of these, 1845 (6.5%) attendances were self-managed by 1555 individuals (8.3% of all clients). Of those who self-managed, 646 (35%) obtained a chlamydia and gonorrhoea test only, 597 (32%) obtained condoms only and 488 (27%) obtained a pregnancy test only. Users valued the opportunity to self-manage because of the reduced waiting times, autonomy and privacy that such a service offers. Some prefer the additional support offered within a clinical consultation. Users made personalised decisions about self-management based on time pressure, need for additional services and preferred source of support. Users often required help and advice from client support workers to complete the self-management process. This created problems with confidentiality. CONCLUSIONS: Self-management is an acceptable option within sexual health services if informal support is available. Self-management options in clinical services could mean that 8% of clients at 6% of visits do not need to see a clinician, thus freeing up clinical capacity.

Involving service users in sexual health service development.

OBJECTIVES: The study objectives were to document users' experience of family planning and genitourinary medicine clinics and young people's services working within the time constraints of rapid service development and maximising the utility of this data for service improvement. METHODS: A total of 93 users of family planning and genitourinary medicine services participated in one of 13 facilitated discussion groups. Some 61% of the sample were women, 64% were aged over 25 years and 47% were Black Caribbean or Black African. The clinic journey was drawn on a wall covered with paper and participants added their comments during the discussion. RESULTS: Users had similar concerns across the three service types. Users perceived some receptionists and clinicians as un-friendly and judgmental and described others providing a quality service often under difficult conditions. Reception was insufficiently confidential, waiting environments uncomfortable, waiting times long and more information was needed throughout service use. CONCLUSIONS: Those elements of sexual health services known to be a source of dissatisfaction among young people may also be a problem for older service users and are experienced across different types of sexual health service. This preliminary study demonstrates the feasibility and acceptability of focus group evaluations of sexual health services. This approach generates qualitative data from relatively large numbers of users within a time-scale consistent with service development.