Evaluation of a testing-only "express" visit option to enhance efficiency in a busy STI clinic.
OBJECTIVE
To evaluate the use of a testing-only "express" visit option to enhance efficiency in a busy STI clinic.


METHODS
At the Denver Metro Health Clinic, clients at low risk for sexually transmitted infections (STI) are offered an express visit comprised of a urine test for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) as well as optional syphilis and human immunodeficiency virus (HIV) testing, but no physical examination. Higher risk clients (STI-related symptoms, contact to STI, men having sex with men, injection drug use, exchange of sex for money or drugs) are offered a comprehensive visit that includes a physical examination. The triage system was evaluated for the period April 2005--July 2006 by comparing rates of CT, GC, syphilis, and HIV between the 2 visit options.


RESULTS
Of 13,447 clients with new visits, 3284 (24.4%) were express visits. When compared with clients with comprehensive visits, express visit clients had lower rates of CT (8.1% vs. 17.2%), GC (0.9% vs. 7.4%), syphilis (0.7% vs. 1.2%), and HIV (0.1% vs. 0.2%). Of 2969 STI cases, only 10.8% were diagnosed among clients with express visits. Express visits resulted in a 39% time saving for men and a 56% for women. With the possible exception of asymptomatic urethritis among men, underdiagnosis of STI beyond CT, GC, syphilis, and HIV among express visit clients appeared to be low.


CONCLUSIONS
The triage system at DMHC effectively selects clients at highest risk for STI and increases clinic efficiency.
Shamos
Sara J
SJ
Denver Public Health Department, Denver, Colorado 80204-4506, USA.
Mettenbrink
Christie J
CJ
Subiadur
Julie A
JA
Mitchell
Brandy L
BL
Rietmeijer
Cornelis A
CA
D015492:AIDS Serodiagnosis; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D002690:Chlamydia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D021141:Nucleic Acid Amplification Techniques / Q000379:methods*; D009819:Office Visits / Q000706:statistics & numerical data*; D015995:Prevalence; D012749:Sexually Transmitted Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013587:Syphilis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D013997:Time Factors