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EDITOR- In his editorial, Mike Catchpole asserts that "new
opportunities for controlling sexually transmitted infections (STIs) come
from strategies that will reduce the period of infectiousness of
individuals" including "more accessible services."1Indeed the aims of open
and rapid access have long been emphasised in sexual health care
provision.2,3
Our experience locally reflects the national trend for increasing
numbers of new genitourinary medicine clinic attendees and acute STI
diagnoses 4, with a resultant rise in our waiting time for a new (female)
appointment to an unacceptable 7-10 days. We therefore recently piloted a
daily walk-in clinic in parallel with our booked appointments.
This produced significant reductions in waiting time (by 65% to 2-4
days), default rate and extra patient burden on booked clinics. It also
enabled the Health Advisors to spend less time triaging patients to assess
the need for urgent consultation, thereby redirecting more resources to
treatment, sexual health education and counselling, and partner
notification. Importantly, our walk-in clinic population had a
significantly higher prevalence of acute STI (33% vs 22% in the booked
group, OR 1.72 (95% CI 1.33-2.24), p<_0.0001. p="p"/> In the climate of ever-increasing demand on the service, Foley et al
suggest that only process change will facilitate our treatment aims5. We
feel this parallel system is one such example and have therefore
introduced it into our normal service.
Amy Evans specialist registrar in genitourinary medicine
Janet Wilson consultant physician in genitourinary medicine
Centre for Sexual Health, General Infirmary at Leeds, Leeds LS1 3EX.
Competing interests: none.
References
1. Catchpole M. Sexually transmitted infections: control strategies.
BMJ 2001; 322:1135-1136.
2. The National Health Service (Venereal Diseases) Regulations 1974. 1974
3. Monks Working Party. Report of the working group to examine the
workloads in genitourinary medicine clinics. London: Department of Health,
November 1988.
4. PHLS, DHSS&PS, and the Scottish ISD(D)5 Collaborative Group. Trends
in sexually transmitted infections in the United Kingdom, 1990-1999.
London: Public Health Laboratory Service, 2000.
5. Foley E, Patel R, Green N, Rowen D. Access to genitourinary medicine
clinics in the United Kingdom. Sex Transm Inf 2001:77:12-14.
In his editorial Dr Catchpole (1) suggest that evidence exists that
screening is effective in controlling genital chlamydia infection. The two
studies quoted provide only very limited evidence. The Swedish experience
(2) describes an uncontrolled observational longitudinal study while the
randomised controlled trial of chlamydia screening (3) had PID and not
incident or prevalent genital chlamydia infection as an outcome.
To determine if chlamydia screening reduces the incidence of genital
chlamydia infection we will require a controlled cohort study or better a
cluster randomised trial. Should chlamydia screening be introduced such a
study would not be difficult to arrange provided screening is phased in
and unscreened control populations remain studies.
1 Catchpole M. Sexually transmitted infections: control strategies.
BMJ 2001;322:1135-1136
2 Kamwendo F, Forslin R, Bodin L, Danielsson D. Programme to reduce
pelvic inflammatory diseasethe Swedish experience. Lancet 1998; 351(suppl
iii): 25-28
3 Scholes D, Stergachis A, Heidrich F, Andrilla H, Holmes KK, Stamm
W. Prevention of pelvic inflammatory disease by screening for cervical
chlamydia infection. N Engl J Med 1996; 334: 1362-1366
Simple process changes can reduce infectiousness
EDITOR- In his editorial, Mike Catchpole asserts that "new
opportunities for controlling sexually transmitted infections (STIs) come
from strategies that will reduce the period of infectiousness of
individuals" including "more accessible services."1Indeed the aims of open
and rapid access have long been emphasised in sexual health care
provision.2,3
Our experience locally reflects the national trend for increasing
numbers of new genitourinary medicine clinic attendees and acute STI
diagnoses 4, with a resultant rise in our waiting time for a new (female)
appointment to an unacceptable 7-10 days. We therefore recently piloted a
daily walk-in clinic in parallel with our booked appointments.
This produced significant reductions in waiting time (by 65% to 2-4
days), default rate and extra patient burden on booked clinics. It also
enabled the Health Advisors to spend less time triaging patients to assess
the need for urgent consultation, thereby redirecting more resources to
treatment, sexual health education and counselling, and partner
notification. Importantly, our walk-in clinic population had a
significantly higher prevalence of acute STI (33% vs 22% in the booked
group, OR 1.72 (95% CI 1.33-2.24), p<_0.0001. p="p"/> In the climate of ever-increasing demand on the service, Foley et al
suggest that only process change will facilitate our treatment aims5. We
feel this parallel system is one such example and have therefore
introduced it into our normal service.
Amy Evans
specialist registrar in genitourinary medicine
evansam@ulth.northy.nhs.uk
Caroline Sutton
health advisor
Janet Wilson
consultant physician in genitourinary medicine
Centre for Sexual Health, General Infirmary at Leeds, Leeds LS1 3EX.
Competing interests: none.
References
1. Catchpole M. Sexually transmitted infections: control strategies.
BMJ 2001; 322:1135-1136.
2. The National Health Service (Venereal Diseases) Regulations 1974. 1974
3. Monks Working Party. Report of the working group to examine the
workloads in genitourinary medicine clinics. London: Department of Health,
November 1988.
4. PHLS, DHSS&PS, and the Scottish ISD(D)5 Collaborative Group. Trends
in sexually transmitted infections in the United Kingdom, 1990-1999.
London: Public Health Laboratory Service, 2000.
5. Foley E, Patel R, Green N, Rowen D. Access to genitourinary medicine
clinics in the United Kingdom. Sex Transm Inf 2001:77:12-14.
Competing interests: No competing interests