Failure to see patients requesting a sexual health appointment within the UK government’s target of 48 hours does not have public health consequences, according to a study published in the December edition of Sexually Transmitted Infections. Patients who were not seen within 48 hours did not have a higher prevalence of sexually transmitted infections than those seen within the government’s target. Nor did patients who were not seen promptly engage in any risky sexual behaviour.
Between 1996 and 2002, there was a significant increase in the number of new sexually transmitted infections diagnosed in the UK and sexual health clinics became much busier. This meant that access to services deteriorated and the UK government set a target that all patients contacting sexual health services should be offered an appointment within 48 hours. This target has been largely met. A second target that 95% of patients should be seen within 48 hours is proving more difficult to meet.
Investigators from Southampton therefore designed a study to examine the potential public health implications of failure to see sexual health patients within 48 hours of a request for an appointment.
Their study was retrospective in design and included 3110 patients who booked appointments at the city’s genitourinary medicine clinic between December 2007 and February 2008. All patients are offered an appointment within 48 hours. However, for reasons of choice, some patients choose to delay their appointment.
The investigators gathered information on waiting time for patients delaying their appointment as well as demographics, the sexually transmitted infection diagnosed, and risky sexual behaviour undertaken during the interval between contacting the clinic and attending for an appointment.
Overall, 310 (10%) patients opted to delay their appointment. These patients were seen a median of six days after contacting the clinic (weekends, when the clinic is closed, included) and within a median of three days if weekends were excluded.
Patients delaying appointments were more likely to be female (p < 0.001), aged 16-24 (p < 0.01), of white ethnicity (p < 0.007), employed (p < 0.001) and to live in Southampton (p < 0.001).
There was no difference in the prevalence or type of sexually transmitted infections diagnosed in patients seen within 48 hours (22%) and those delaying their appointment (20%).
Most of the patients delaying their appointment attended for a sexual health check-up when they did not have any symptoms of an infection (62%), but 30% of those delaying did have symptoms of an infection and 6% were contacts of people diagnosed with an infection.
None of the patients delaying their appointment reported sex with a new partner, or sex with a previous contact. But the investigators note that they were reliant upon patients' self-report for this measurement and that "social-desirability" could have affected replies.
“This study demonstrates that even when 100% of patients requesting to be seen in a GUM clinic can be offered an appointment within 48 hours, a proportion will elect to wait”, write the investigators.
The researchers note that there was no difference in the rates of sexually transmitted infections between patients seen within 48 hours and those choosing to wait, and that those waiting did not report any sexual activity likely to have exposed a partner to an infection.
They therefore conclude that the government target that 95% of patients contacting a sexual health clinic should be seen within 48 hours is “not justified for public health reasons.” The investigators call for further research if “targets for ‘when seen’ are to become evidence-based.”
Sanmani, L et al. Patient-initiated delay at a genitourinary medicine clinic: are there public health consequences? Sex Transm Infect 84: 560-62, 2008.