How much do delayed healthcare seeking, delayed care provision, and diversion from primary care contribute to the transmission of STIs?
OBJECTIVE
To quantify the contribution of patient delay, provider delay, and diversion between services to delayed access to genitourinary medicine (GUM) clinics. To describe the factors associated with delay, and their contribution to STI transmission.


METHODS
Cross-sectional survey of 3184 consecutive new patients attending four GUM clinics purposively selected from across England to represent different types of population. Patients completed a short written questionnaire that collected data on sociodemographics, access, and health-seeking behaviour. Questionnaires were then linked to routinely collected individual-level demographic and diagnostic data.


RESULTS
Patient delay is a median of 7 days, and does not vary by demographic or social characteristics, or by clinic. However, attendance at a walk-in appointment was associated with a marked reduction in patient delay and provider delay. Among symptomatics, 44.8% of men and 58.0% of women continued to have sex while awaiting treatment, with 7.0% reporting sex with >1 partner; 4.2% of symptomatic patients reported sex without using condoms with new partner(s) since their symptoms had begun. Approximately 25% of all patients had already sought or received care in general practice, and these patients experienced greater provider delay.


CONCLUSIONS
Walk-in services are associated with a reduction in patient and provider delay, and should be available to all populations. Patients attending primary care require clear care pathways when referred on to GUM clinics. Health promotion should encourage symptomatic patients to seek care quickly, and to avoid sexual contact before treatment.
Mercer
Catherine H
CH
Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, London, UK. cmercer@gum.ucl.ac.uk
Sutcliffe
Lorna
L
Johnson
Anne M
AM
White
Peter J
PJ
Brook
Gary
G
Ross
Jonathan D C
JD
Dhar
Jyoti
J
Horner
Paddy
P
Keane
Frances
F
Jungmann
Eva
E
Sweeney
John
J
Kinghorn
George
G
Garnett
Geoff G
GG
Stephenson
Judith M
JM
Cassell
Jackie A
JA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D004739:England; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000635:transmission*