Ambulatory STD management in an inner-city emergency department: descriptive epidemiology, care utilization patterns, and patient perceptions of local public STD clinics.

Abstract

In conjunction with a lack of primary and preventive care, many patients are treated in emergency departments (EDs) for sexually transmitted diseases (STDs). To epidemiologically characterize patients accessing an inner-city ED for treatment of STDs. One hundred patients 17 years or older who were treated for an STD or who had conditions that were given syndromic or presumptive diagnoses of an STD participated in this prospective case series. Cases were identified on the basis of history and physical examination. Patients were interviewed to collect information on demographics, drug and alcohol use, current symptoms, self-medication, and health care access. A total of 98% of patients who were approached participated. Two thirds of the participants were female. Women were more likely than men to have health insurance, Medical Assistance, and a regular source of health care. Injecting drug use was associated with a 5.3 increase in the odds ratio of delayed treatment seeking (P = 0.038). Effort to self-treat was associated with a 3.2 increase in the odds of delayed treatment seeking (P = 0.015). Being female was associated with a 4.1 increase in the odds of self-treatment (P = 0.009). This study identifies several potential barriers to appropriate health care access and use. The study also identifies the ED as a potential source of intervention for more comprehensive health care and an entry into the health care system for a difficult-to-reach patient population.