Getting it Right: The Impact of Point-of-Care Testing for Gonorrhea and Chlamydia in the Urgent Care Setting

Abstract

Sexually transmitted infections (STIs), including Neisseria gonorrhea and Chlamydia trachomatis, have been at the forefront of public health and world health initiatives because of increasing prevalence, antimicrobial resistance trends, and immense economic health care burdens. Current STI laboratory-based testing impedes timely and accurate treatment in urgent care clinics (UCCs) and emergent care settings; the typical 3- to 5-day turnaround for testing results is not efficient in these settings. Of significance, UCCs and emergency settings often serve as the only point of contact for many exposed or affected individuals, further complicating appropriate treatment and follow-up care. This quality improvement project was conducted at a high-volume, suburban UCC to evaluate the implementation of nucleic acid amplification test (NAAT) point-of-care (POC) STI screening for gonorrhea and chlamydia. Analysis included comparison of appropriate STI treatment based on laboratory results among 100 patients preintervention and 100 patients postintervention, financial feasibility of the POC testing intervention, and staff satisfaction measurement. Results show that STI treatment appropriateness dramatically improved with NAAT; the innovation exceeded cost neutrality by creating revenue through appropriate billing and coding, and clinical staff were highly satisfied using the new testing protocol. The results of this study support the use of POC testing using NAAT for the diagnosis of urogenital gonorrhea and chlamydia infections in urgent and emergent care settings and highlight implications for adoption, sustainability, and expansion into other clinic settings.