Interventions to increase access to STI services: A study of England's ‘High Impact Changes' across three central London clinics
Résumé
Background Increasing access to sexual health services is a key objective for the Department of Health (DH) in England and Wales. In 2006 the DH published ten high impact changes (HICs) designed to enhance 48-hour access to genitourinary medicine services. However, there is limited evidence on the effectiveness of the proposed interventions. We therefore evaluated the implementation of five HICs in three sexual health clinics over four years. These HICs included a text message results service, nurse-delivered asymptomatic service, clinic refurbishment, a centralized booking service and an electronic appointment system. Methods The impact of HICs was evaluated by measuring clinical activity, number of sexual health screens performed and patients seen within 48 hours. These data were obtained from the clinic database, KC60 coding returns and Health Protection Agency waiting time surveys, respectively. Results The median number of new patients seen per month increased from 3635 to 4263 following the implementation of the five high impact changes. The follow-up to new patient ratio fell from 0.67 to 0.21 during this study. The biggest fall corresponded with a rise in patients receiving results by text message, from zero to 40%. Only the centralized booking service was associated with a significant increase in the number of new patients seen. Discussion Providing results by text message was associated with a reduced number of follow-up patients whilst implementation of a centralized booking service coincided with a significant increase in patient access. Further research is required to evaluate the relative importance of the other HICs.
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