title: Rationale and development of a survey tool for describing and auditing the composition of, and flows between, specialist and community clinical services for sexually transmitted infections.
abstract: BACKGROUND
  National health strategies have called for an expansion of the role of primary care in England to increase access to sexual health services. However, there is little guidance for service planners and commissioners as to the public health impact of different combinations of specialist genitourinary medicine (GUM) clinics and primary care based services for local populations. Service planning for infectious diseases like sexually transmitted infections (STI) is further complicated because the goal of early detection and treatment is not only to improve the health of the individual, but to benefit the wider population and reduce future treatment costs by preventing onward transmission. Therefore, we are developing a survey tool that will enable service planners to better understand the needs of their local STI care-seeking population and which will help inform evidence-based decision-making about current and future service configurations. Here we describe the rationale and development of this survey tool.
  
  
  METHODS
  A pen-and-paper questionnaire asking about sociodemographics, reasons for attendance, care pathways, and recent sexual risk behaviours, is being developed for patients to complete in waiting rooms of diverse clinical services, including GUM clinics and primary-care based services in sociodemographically- and geographically-contrasting populations in England. The questionnaire was cognitively tested before being piloted. In the pilot, 67% of patients participated, of whom 84% consented to our linking their questionnaire to data on STI testing and diagnosis and partner notification outcomes from their clinical records.
  
  
  CONCLUSIONS
  The pilot study suggests that both the questionnaire and its linkage to routinely-collected clinical data are likely to be acceptable to patients. By supplementing existing surveillance, data gathered by the survey tool will inform service planners' and providers' understanding of the needs and care-pathways of their patients, facilitating improved services and greater public health benefit.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK.
authors.forename: Catherine Rh
authors.initials: CR
authors.lastname: Aicken
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Estcourt
authors.forename: Frances
authors.initials: F
authors.lastname: Keane
authors.forename: Gary
authors.initials: G
authors.lastname: Brook
authors.forename: Greta
authors.initials: G
authors.lastname: Rait
authors.forename: Peter J
authors.initials: PJ
authors.lastname: White
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D003153:Community Health Services; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D015438:Health Behavior; D006301:Health Services Needs and Demand; D006306:Health Surveys / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D013038:Specialization; D014566:Urogenital System / Q000382:microbiology; D055815:Young Adult