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The 2014 Public Health England draft strategic framework highlights the disproportionately poorer health and well-being of gay, bisexual and other men who have sex with men (GBMSM) in the areas of sexual health, mental health and substance use.1 Unlike other clinical settings, GUM clinics are unique in routinely establishing sexual orientation information from patients and are therefore also well placed for the early identification of mental health and substance misuse problems in GBMSM.
In line with the national strategy to make ‘every contact count’, we introduced a holistic clinical proforma for the assessment of GBMSM accessing our sexual health service, which included an assessment of mental health and substance use. We carried out a retrospective audit to determine whether or not use of such a proforma improved documentation and identification of factors potentially amenable to brief interventions or referral.
A baseline audit was carried out in July 2014 following which the clinical proforma was introduced into general GUM clinics in conjunction with increased involvement of health advisors in the GBMSM care pathway. The audit was repeated in January 2015 when the proforma had increased from 32% to 62% of clinic visits (n=83).
We observed significant improvements in the documentation of recreational drug use (57% vs 82%, p=0.02), concerns about alcohol and mental health (14% vs 47%, p=0.002) and sexualised substance use or ‘chemsex’ (38% vs 64%, p=0.03). Small but statistically insignificant improvements were also seen in the documentation of other risk behaviours such as intravenous drug use and recent unprotected anal sex.
The use of a structured holistic proforma for the clinical assessment of GBMSM in sexual health clinics may improve the identification of opportunities for evidence-based behavioural or biological intervention to help make ‘every contact count’ to improve health and well-being of this vulnerable population.
Contributors All authors contributed to the audit design. MJL and BO performed the data collection and MJL, BO and AH performed the data analysis. All authors contributed to the drafting of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.
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