title: Interventions to increase access to STI services: a study of England's 'high-impact changes' across three central London clinics.
abstract: BACKGROUND
  Increasing access to sexual health services is a key objective for the Department of Health in England and Wales. In 2006 it published 10 high-impact changes (HICs) designed to enhance 48 h access to genitourinary medicine services. However, there is limited evidence on the effectiveness of the proposed interventions.
  
  
  OBJECTIVE
  To evaluate the implementation of five HICs in three sexual health clinics over 4 years. These HICs included a text message results service, nurse-delivered asymptomatic service, clinic refurbishment, a centralised booking service and an electronic appointment system.
  
  
  METHODS
  The effect of HICs was evaluated by measuring clinical activity, number of sexual health screens performed, and patients seen within 48 h. These data were obtained from the clinic database, mandatory reports and Health Protection Agency waiting time surveys, respectively.
  
  
  RESULTS
  The median number of new patients seen per month increased from 3635 to 4263 following the implementation of the five HICs. The follow-up/new patient ratio fell from 0.67 to 0.21 during the study. The biggest fall corresponded to a rise in patients receiving results by text message, from 0% to 40%. Only the centralised booking service was associated with a significant increase in the number of new patients seen.
  
  
  CONCLUSIONS
  Providing results by text message was associated with a reduced number of follow-up patients, while implementation of a centralised booking service coincided with a significant increase in patient access. Further research is required to evaluate the relative importance of the other HICs.
authors.affiliation: Chelsea and WestminsterHospital NHS Foundation Trust,London, UK. a.menon-johansson@nhs.net
authors.forename: A S
authors.initials: AS
authors.lastname: Menon-Johansson
authors.forename: C E
authors.initials: CE
authors.lastname: Cohen
authors.forename: R
authors.initials: R
authors.lastname: Jones
authors.forename: N
authors.initials: N
authors.lastname: Nwokolo
authors.forename: A
authors.initials: A
authors.lastname: McOwan
authors.forename: S E
authors.initials: SE
authors.lastname: Barton
authors.forename: S
authors.initials: S
authors.lastname: Mandalia
authors.forename: A K
authors.initials: AK
authors.lastname: Sullivan
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D001071:Appointments and Schedules; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D009732:Nursing Care / Q000458:organization & administration / Q000706:statistics & numerical data; D015397:Program Evaluation; D012749:Sexually Transmitted Diseases / Q000628:therapy*