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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.