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Follow up rates for victims of sexual assault have traditionally been low, ranging from 10%1 to 31%.2 Rates improved if a follow up appointment was arranged at a genitourinary medicine clinic (GUM) clinic—50% of the 70% of patients for whom an appointment was made.3
FAMSAC (Forensic and Medical Sexual Assault Care) is a medical sexual assault service that has been integrated into an existing sexual health clinic for the past 19 months. A total of 114 sexual assault patients have used the service since November 2001(106 females, 8 males). Consent for follow up contact from the nurse coordinator of FAMSAC is sought at the initial consultation; this occurs in the first week after the report of sexual assault.
The following elements of care are addressed at the follow up visit:
Follow up screening for sexually transmitted infections and hepatitis B vaccination (initiation or continuation)
Follow up pregnancy testing as necessary (emergency contraception is given at the initial medical examination)
Management and follow up of injuries as necessary
Referral to counselling services (patients are offered immediate independent support at the time of medical examination)
Discussion of legal matters (police action, victim’s compensation, etc)
Health promotion information and safety awareness strategies.
Patient follow up is the responsibility of the nurse coordinator with medical support as required, other duties include organising the preparation of legal reports, court appearances, and support of the medical officers ensuring continuity of care for the patient and minimal delay in the legal process.
To date we have contacted 97/114 (85%) of our patients. These rates are significantly higher than those reported by Herbert,1 who reports a loss to follow up of 46% within 24–48 hours. This may be due in part to better access to telephones since her 1988–90 study—53% of our patients own a mobile telephone and 80% of patients gave a home contact telephone number. A total of 17 patients were unable to be contacted.
We offer a further opportunity for contact 3 months after the assault. To date 73 patients have been eligible; of these 59 (80%) have been contacted and 39 have attended (66%). Three patients who received HIV prophylaxis were offered a 6 month follow up appointment; all of those have attended.
The sexual health clinic appears to be an ideal venue for follow up of these patients, who appear to be at higher risk of acquiring a sexually transmitted infection.4 The nurse coordinator model has enabled the follow up of patients at higher rates than previously reported.