Telephone-triage services do not lead to an increased wait time for assessment of gonorrhoea in symptomatic patients.

William Jasper,Madeleine Macdonald,Elizabeth Foley,Danayan Luxmanan,Rajul Patel

doi:10.1177/0956462421999280

William Jasper, Madeleine Macdonald + Show 3 more

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https://doi.org/10.1177/0956462421999280

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Abstract

In Spring 2017, Southampton and Portsmouth Sexual Health Services (SHSs) replaced an overstretched walk-in service with a telephone-triage service: patients calling that were symptomatic, vulnerable or at high risk of having an STI were invited into a clinic, whereas others were signposted to remote self-sample NHS postal testing services. This study aimed to establish whether patient care was disadvantaged by the introduction of the triage service. Electronic patient notes for all patients attending for treatment of gonorrhoea for two years before and for two years after the service change were interrogated; the site of infection and duration of symptoms before testing were compared. Of all patients attending for treatment of gonorrhoea in the study period, 499 patients (39% of cases) were symptomatic at testing: 364 had urethral symptoms, 45 had rectal symptoms and 18 had pharyngeal symptoms. 72.4% of patients with urethral symptoms were seen after the introduction of the triage system. Median wait times for patients with urethral symptoms rose from 6 (IQR = 3–7) to 7 (IQR = 3.75–14) days – although this increase was not statistically significant (p = 0.064). There was not a statistically significant difference between the rectal symptom groups (p = 0.422) and too few patients attended with pharyngeal symptoms to warrant analysis. Despite some outliers, the telephone-triage service did not increase wait times for patients attending STI services with symptomatic gonorrhoea and may have inadvertently increased access to services for those most at risk.

Highlights

Sexual health services (SHSs) are under ever-increasing pressure, evidenced by rising patient numbers[1] and reductions in public health budgets.[2]
All unique cases of gonorrhoea attending over the 4 year study period in Solent were reviewed. 499/1279 patients attending for treatment of gonorrhoea (39% of all cases) were symptomatic at presentation. 364 (72.9%) of these had urethral symptoms, 45 (9%) had rectal symptoms and 18 (3.6%) had pharyngeal symptoms
Of the patients diagnosed after attendance in service (445/499; 89.2%), only those patients where a clear duration of symptoms could be calculated from the notes were further analysed

Summary

Introduction

Sexual health services (SHSs) are under ever-increasing pressure, evidenced by rising patient numbers[1] and reductions in public health budgets.[2]. In 2017, Southampton and Portsmouth SHSs (Royal South Hants Hospital and St Marys Community Health Campus) adopted a telephone-triage service. This replaced the previous open-access walk-in service for STI testing, where patients were able to attend the service and expect consultation with testing. The new system replaced walk-in appointments, and instead, patients were triaged over the phone. Those that were symptomatic, vulnerable or at high risk of having an STI were invited into the clinic at a fixed time for testing. Those that did not fit these criteria were sent free self-sampling tests to perform home-based testing and were not invited into the clinic unless test results were positive

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