• sexually transmitted diseases
• hospital clinic
• outreach service

The national strategy for sexual health and HIV recommends that genitourinary medicine (GUM) outreach services be used as a means of expanding patient access to testing and advice for STDs.¹ However, there is limited published work to demonstrate the effectiveness of outreach services in GUM.^2,3 Having established an outreach GUM service in 1997 we reported initial data in 1998⁴ and now we report a more in-depth examination of the factors that affect access to care and a further evaluation of the differences between patients attending the outreach and main clinics.

The Patrick Clements Clinic is a long established hospital based GUM clinic (about 16 000 attendances per year) in north west London. It offers a daily, weekday, open access, walk-in service. The Windsor Clinic (WC) is an outreach GUM service based at a GP practice building in Wembley. It opens one afternoon a week with mixed appointment and walk-in slots, staffed by a consultant and a nurse.

Fifty five patients were interviewed at the two study sites: 35 at the main clinic and 20 at the outreach clinic. The taped interviews were later analysed to look for themes. Demographic and disease data were also analysed from consecutive attendees for a week at the hospital clinic and 6 months at the outreach clinic using the clinic database. Data were compared with the previously published study.⁴ Differences were tested with the χ² test.

The most notable differences between interviewees were the higher rate of previous GUM attendance, 28/35 (80%) v 5/20 (25%), and greater numbers with casual partners, 14/35 (40%) v 1/20 (5%), in those attending the hospital based clinic compared with outreach patients. Interviewees reported that location played an important part in their decision as to which site to attend as 46/55 (83%) attended the clinic that was closest to home or work. Lack of awareness of alternative clinics did not seem to be a significant factor influencing the site attended, as 34/55 (62%) were aware of alternatives. Confidentiality and stigma were not stated as important issues.

Demographic and disease data on 209 consecutive attendees at the hospital based clinic and 111 consecutive attendees at the outreach clinic in 2001 were compared (table 1⇓). The data show that outreach patients were more likely to be teenagers, women, African, and first time clinic attendees. STD rates were similar at both sites. These data are similar to those obtained in 1998 although the ethnic mix has changed.

It has long been assumed that stigma and confidentiality were the main influences on patient access to GUM services and ever since the Monk report there has been a move towards overcoming these barriers.⁵ This study shows that the outreach service attracted a new and very different population, in terms of demographics and GUM experience, but the overriding influence on the patients’ choice of site of care was closeness to home or work. However, outreach services such as this are also relatively time consuming and expensive compared with the larger clinic. These factors should be strongly considered when developing new outreach services.