Abstract

BackgroundComputer assisted self interviewing (CASI) has been used at the Melbourne Sexual Health Centre (MSHC) since 2008 for obtaining sexual history and identifying patients' risk factors for sexually transmitted infections (STIs). We aimed to evaluate the impact of CASI operating at MSHC.Methodology/Principal FindingsThe proportion of patients who decline to answer questions using CASI was determined. We then compared consultation times and STI-testing rates during comparable CASI and non-CASI operating periods. Patients and staff completed anonymous questionnaires about their experience with CASI. 14,190 patients completed CASI during the audit period. Men were more likely than women to decline questions about the number of partners they had of the opposite sex (4.4% v 3.6%, p = 0.05) and same sex (8.9% v 0%, p<0.001). One third (34%) of HIV-positive men declined the number of partners they had and 11–17% declined questions about condom use. Women were more likely than men to decline to answer questions about condom use (2.9% v 2.3%, p = 0.05). There was no difference in the mean consultation times during CASI and non-CASI operating periods (p≥0.17). Only the proportion of women tested for chlamydia differed between the CASI and non-CASI period (84% v 88% respectively, p<0.01). 267 patients completed the survey about CASI. Most (72% men and 69% women) were comfortable using the computer and reported that all their answers were accurate (76% men and 71% women). Half preferred CASI but 18% would have preferred a clinician to have asked the questions. 39 clinicians completed the staff survey. Clinicians felt that for some STI risk factors (range 11%–44%), face-to-face questioning was more accurate than CASI. Only 5% were unsatisfied with CASI.ConclusionsWe have demonstrated that CASI is acceptable to both patients and clinicians in a sexual health setting and does not adversely affect various measures of clinical output.

Highlights

  • The prevalence of sexually transmitted infections (STIs) is closely related to the community’s access to clinical services [1]

  • We have demonstrated that Computer assisted self interviewing (CASI) is acceptable to both patients and clinicians in a sexual health setting and does not adversely affect various measures of clinical output

  • We looked at chlamydia tests, HIV tests for all patients and anal swabs taken from men who have sex with men (MSM) for either chlamydia and/or gonorrhea

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Summary

Introduction

The prevalence of sexually transmitted infections (STIs) is closely related to the community’s access to clinical services [1]. This was illustrated in the UK when under-funding of genitourinary medicine (GUM) clinics led to reduced access to services and increases in gonorrhea rates which subsequently stabilized and declined with improved access [2,3]. It was our hope that CASI may lead to improved efficiency and reduced cost of our sexual health clinical service [5,6,7,8,9]. Computer assisted self interviewing (CASI) has been used at the Melbourne Sexual Health Centre (MSHC) since 2008 for obtaining sexual history and identifying patients’ risk factors for sexually transmitted infections (STIs). We aimed to evaluate the impact of CASI operating at MSHC

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