title: Building the bypass--implications of improved access to sexual healthcare: evidence from surveys of patients attending contrasting genitourinary medicine clinics across England in 2004/2005 and 2009.
abstract: OBJECTIVE
  The objective of this study was to examine changes in patient routes into genitourinary medicine (GUM) clinics since policy changes in England sought to improve access to sexual healthcare.
  
  
  METHODS
  Cross-sectional patient surveys at contrasting GUM clinics in England in 2004/2005 (seven clinics, 4600 patients) and 2009 (four clinics, 1504 patients). Patients completed a short pen-and-paper questionnaire that was then linked to an extract of their clinical data.
  
  
  RESULTS
  Symptoms remained the most common reason patients cited for attending GUM (46% in both surveys), yet the proportion of patients having sexually transmitted infection (STI) diagnosis/es declined between 2004/2005 and 2009: 38%-29% of men and 28%-17% of women. Patients in 2009 waited less time before seeking care: median 7 days (2004/2005) versus 3 days (2009), in line with shorter GUM waiting times (median 7 vs 0 days, respectively). Fewer GUM patients in 2009 first sought care elsewhere (23% vs 39% in 2004/2005), largely from general practice, extending their time to attending GUM by a median of 2 days in 2009 (vs 5 days in 2004/2005). Patients with symptoms in 2009 were less likely than patients in 2004/2005 to report sex since recognising a need to seek care, but this was still reported by 25% of men and 38% of women (vs 44% and 58%, respectively, in 2004/2005).
  
  
  CONCLUSIONS
  Patient routes to GUM shortened between 2004/2005 and 2009. While GUM patients in 2009 were less likely overall to have STIs diagnosed, perhaps reflecting lower risk behaviour, there remains a substantial proportion of high-risk individuals requiring comprehensive care. Behavioural surveillance across all STI services is therefore essential to monitor and maximise their public health impact.
authors.affiliation: Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, London, UK. c.mercer@ucl.ac.uk
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
authors.forename: Catherine R H
authors.initials: CR
authors.lastname: Aicken
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: Jackie A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D003075:Coitus; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D017678:Sex Distribution; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D011795:Surveys and Questionnaires; D014686:Venereology / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D014850:Waiting Lists; D055815:Young Adult