title: Maintaining patient access to GUM clinics: is it compatible with appointments?
abstract: OBJECTIVE
  To determine whether a planned change from a walk-in service to a system in which 35% of appointments were prebooked and 65% obtained on the day, preserved access to the service for patients with, or at risk of, STIs. To describe patients' attitudes and behaviours in relation to accessing the clinic, and relate these to disease status and other epidemiological factors. To evaluate the effect of the change on clinical outcomes. To develop a tool for evaluating access to services.
  
  
  METHODS
  A natural experiment was studied, in which a cohort of patients attending just before the change in appointments policy (phase 1) was compared with a cohort following the change (phase 2). A questionnaire was administered to all new patients, and linked to disaggregated epidemiological and demographic data and case notes.
  
  
  RESULTS
  The age, ethnic, symptom status, and disease mix of the clinic did not change significantly, and more patients were seen in phase 2. Time from telephoning to being seen did not change. Under 25s and Afro-Caribbeans used prebooked appointments less than others. Partner notification improved and HIV testing rates increased, while staff preferred the new system.
  
  
  CONCLUSIONS
  This specific appointment system in a GUM clinic preserved access for high risk groups. However, this may not generalise to systems with a higher proportion of prebooked appointments.
authors.affiliation: Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, Mortimer Market Centre, Off Capper Street, London WC1E 6AU, UK. jackiec@quadrivium.demon.co.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Cassell
authors.forename: M G
authors.initials: MG
authors.lastname: Brook
authors.forename: C H
authors.initials: CH
authors.lastname: Mercer
authors.forename: S
authors.initials: S
authors.lastname: Murphy
authors.forename: A M
authors.initials: AM
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D001294:Attitude to Health; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D008131:London; D008297:Male; D012749:Sexually Transmitted Diseases / Q000628:therapy*; D011795:Surveys and Questionnaires