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Improving clinical practice and service delivery
P148 “Fast-track” STD services in an urban STD clinic: increased clinical capacity, but reduced opportunities for same-day treatment
  1. B Stoner1,
  2. H Reno1,
  3. C Brethauer2,
  4. D Spear2,
  5. R Knaup2
  1. 1Washington University, St. Louis, Missouri, USA
  2. 2St. Louis County Department of Health, St. Louis, Missouri, USA

Abstract

Background Public health sexually transmitted disease (STD) clinics in the US continue to face service cutbacks due to financial pressures. “Fast-track” services (urine-based screening without a physical examination) allow for greater patient throughput, but may impede provision of same-day STD treatment.

Objectives (1) to demonstrate the extent to which fast-track implementation leads to increased service capacity; and (2) to document the percentage of fast-track cases with STD requiring further treatment.

Methods Demographic, behavioural, and clinical data analysis from fast-track service delivery in St. Louis County STD Clinic (urban St. Louis, Missouri, USA) from January 2009 to August 2011.

Results Implementation of fast-track services resulted in an increase in clinic throughput of 34.8 patients per month, and a decrease in patients turned away without care (5.6%). Most fast-track patients were male (65.9%), reflecting general clinic demographic trends. Infection rates among fast-track patients were 9.6% for Chlamydia trachomatis and 0.7% for Neisseria gonorrhoeae; these patients were contacted by telephone and instructed to return to clinic for treatment. Effective treatment was documented for 67.0% of infected patients.

Conclusion Implementation of fast-track services resulted in increased clinic capacity. However, substantial staff time and effort were required to ensure adequate treatment for those testing positive for STD. Enhanced risk assessment prior to fast-track screening may help identify those patients who will benefit from full STD clinical examination and same-day treatment.

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