Background Triaging patients to different service levels based on responses to computer-assisted self interview (CASI) could increase the cost-efficiency of providing care in STD clinics.
Methods In October 2010 we began having all patients at the King County STD Clinic provide their medical and sexual histories using CASI. Patients are triaged to express or routine care with a computer algorithm based on CASI data. The express care protocol is to collect specimens for HIV/STD testing without physical examination or counselling. Prior to implementation, we conducted 2 months of parallel data collection in which patients who completed CASI were interviewed by clinicians blinded to CASI results. We used κ statistics to compare CASI and clinician-obtained data. We tracked visit times for walk-in visits in two 10-day periods pre- and post-implementation, and attempted to survey all patients who used CASI on 10 days about interview and visit type preferences.
Results 875 patients completed both CASI and clinician interviews on 33 days (see Abstract O5-S1.06 table 1). Four months post-implementation, 2731 patients had completed CASI, 420 (15%) of whom were triaged to express care. Common reasons for triage to routine care were (mutually exclusive): symptoms (72% of routine care), contact to HIV/STD or a symptomatic partner (12%), and needing a vaccine (12%). Patients triaged to express care had lower rates of gonorrhoea (0.7% vs 5.7%, p<0.001), chlamydial infection (3.0% vs 7.5%, p<0.001) and syphilis (0% vs1.3%, p=0.02) than those triaged to routine care. Chart review and informal qualitative data indicated that clinician adherence to the express care protocol varied. Mean visit times were 32 (SD 3) min pre-implementation and 31 (SD 3) min post-implementation. 133 (39%) of 337 patients completed surveys. 106 (80%) either preferred CASI to clinician interview or had no preference; 27 (59%) of 46 asymptomatic patients preferred express care.
Conclusions Our CASI system collected accurate data on key aspects of the history, effectively triaged patients at lower risk for bacterial STD diagnosis and was acceptable to most patients surveyed. Lack of acceptability among some clinicians and poor patient recall of vaccine history were barriers to full implementation of the triage system. To date, CASI triage has not improved clinic efficiency as measured by visit time. Our experience suggests that non-clinician staff may be required to implement express care in STD Clinics.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.