title: Effectiveness of an urban emergency department call-back system in the successful linkage to treatment of sexually transmitted infections.
abstract: OBJECTIVE
  There is a high incidence of asymptomatic sexually transmitted infections (STIs) in emergency department (ED) patients. There is no historical indication, physical examination finding, or rapidly available laboratory testing specific for detecting STIs in women. This study was conducted to describe the performance of an ED call-back system for STI screening and linkage to care for treatment. Success was defined as the ability to contact STI-positive women who were undertreated and confirm their return for definitive treatment.
  
  
  METHODS
  This retrospective, observational study of women 16 years and older evaluated those undertreated for STIs in the ED during the 13-month study period. A structured chart review was performed to determine the proportion of patients returning to an affiliated hospital ED or clinic for treatment after contact by telephone or letter.
  
  
  RESULTS
  Of 361 patients identified as undertreated, 29.4% (95% confidence interval [CI] 24.7-34.1) did not return for definitive treatment. The method of contact was associated with patient return for treatment. Of the 276 patients contacted by telephone, 19.6% did not return for treatment (95% CI 14.9-24.3); of the 83 patients contacted by letter, 60.2% did not return for treatment (95% CI 49.7-70.8; P < 0.0001).
  
  
  CONCLUSIONS
  A large proportion of patients undertreated for an STI did not return despite a notification of need for further treatment. This study had a high rate of successful telephone contact (76.5%), but contact did not substantially increase the overall proportion of patients who were linked to care and returned to the ED for treatment.
authors.affiliation: From the Department of Emergency Medicine, Wayne State University School of Medicine, the Department of Emergency Medicine, Detroit Medical Center, and Physician Assistant Studies, Wayne State University, Detroit, Michigan.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Lolar
authors.affiliation: From the Department of Emergency Medicine, Wayne State University School of Medicine, the Department of Emergency Medicine, Detroit Medical Center, and Physician Assistant Studies, Wayne State University, Detroit, Michigan.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Sherwin
authors.affiliation: From the Department of Emergency Medicine, Wayne State University School of Medicine, the Department of Emergency Medicine, Detroit Medical Center, and Physician Assistant Studies, Wayne State University, Detroit, Michigan.
authors.forename: Duane M
authors.initials: DM
authors.lastname: Robinson
authors.affiliation: From the Department of Emergency Medicine, Wayne State University School of Medicine, the Department of Emergency Medicine, Detroit Medical Center, and Physician Assistant Studies, Wayne State University, Detroit, Michigan.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Courage
authors.affiliation: From the Department of Emergency Medicine, Wayne State University School of Medicine, the Department of Emergency Medicine, Detroit Medical Center, and Physician Assistant Studies, Wayne State University, Detroit, Michigan.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis* / Q000188:drug therapy; D003142:Communication; D015709:Correspondence as Topic; D004636:Emergency Service, Hospital; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000188:drug therapy; D006786:Hospitals, Urban; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013689:Telephone; D055815:Young Adult