title: How much do delayed healthcare seeking, delayed care provision, and diversion from primary care contribute to the transmission of STIs?
abstract: 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.
authors.affiliation: Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, London, UK. cmercer@gum.ucl.ac.uk
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.forename: Lorna
authors.initials: L
authors.lastname: Sutcliffe
authors.forename: Anne M
authors.initials: AM
authors.lastname: Johnson
authors.forename: Peter J
authors.initials: PJ
authors.lastname: White
authors.forename: Gary
authors.initials: G
authors.lastname: Brook
authors.forename: Jonathan D C
authors.initials: JD
authors.lastname: Ross
authors.forename: Jyoti
authors.initials: J
authors.lastname: Dhar
authors.forename: Paddy
authors.initials: P
authors.lastname: Horner
authors.forename: Frances
authors.initials: F
authors.lastname: Keane
authors.forename: Eva
authors.initials: E
authors.lastname: Jungmann
authors.forename: John
authors.initials: J
authors.lastname: Sweeney
authors.forename: George
authors.initials: G
authors.lastname: Kinghorn
authors.forename: Geoff G
authors.initials: GG
authors.lastname: Garnett
authors.forename: Judith M
authors.initials: JM
authors.lastname: Stephenson
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: 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*