B8d Expediting STD Services: Findings From An STD Clinic Fast-Track Service

Tuesday, March 9, 2010: 4:00 PM
Dogwood A (M1) (Omni Hotel)
Ali Stirland, MBChB, MSc1, Sarah Guerry, MD1, Michael Chien, PhD, (c)1, Timur Durani, MD, MPH, MBA2, Angela Lozano, RN, PHN, MSN3 and Homer Boyd, MD3, 1Sexually Transmitted Disease Program, Los Angeles County Department of Public Health, Los Angeles, CA, 2Communicable Disease Control and Prevention, Los Angeles County Department of Public Health, Los Angeles, 3Community Health Services, Los Angeles County Department of Public Health, Los Angeles

Background: In Los Angeles STD clinics providers see every new patient and visits can be lengthy with multiple stages. Fast-track STD services in other cities require triage and exclude men who have sex with men (MSM).

Objectives: To increase access to and expedite the clinic visit for patients, including MSM, who present for screening, using self-administered questionnaires.

Methods: Commencing May 2008, asymptomatic patients were eligible for fast-track unless they were referrals or STD contacts. Eligibility was determined by a self-administered questionnaire.  Nurses reviewed the questionnaire and offered screening for HIV, syphilis, chlamydia, and gonorrhea (including self-collected rectal swabs and nurse-collected pharyngeal swabs if appropriate).  Evaluation included patient satisfaction surveys, flow analyses, testing volume, and morbidity.  No supplementary staff was added nor the service promoted.

Results: In the first 8 months, 21% (402/1870) of new visits were fast-track with 77% male, 23% female and 1 transgender patient.  MSM comprised 12% (48/402) of fast-track patients compared to 23% (298/1468) of doctor-visit patients.  Only 2% (45/1870) of new patients were reassigned from fast-track to doctor-visit.  The number of new patients/session increased by 31% (from 6.1 to 8.0) compared to the same 8 month period the previous year.  The rate of positive STD tests was lower in fast-track than doctor-visit patients.  There were no new cases of HIV or syphilis in the fast-track patients.  Flow analyses showed a significant decrease in the mean length of clinic visit; all patient visits decreased by 15 minutes while fast track visits decreased by 37 minutes. Patient surveys showed satisfaction the same or higher after implementation.

Conclusions: Implementation of the screening fast-track led to an increase in clinic efficiency, shorter visit time, and more new patients seen/session. 

Implications for Programs, Policy, and/or Research: Programs should consider implementing fast-tracks because they can improve patient access to STD screening.