title: Inequalities in access to genitourinary medicine clinics in the UK: results from a mystery shopper survey.
abstract: This study investigated whether access to genitourinary medicine (GUM) clinics meets UK-recommended standards.
  
  
  
  In January 2014 and 2015, postal questionnaires about appointment and service characteristics were sent to lead clinicians of UK GUM clinics. In February 2014 and 2015, researchers posing as symptomatic and asymptomatic 'patients' contacted clinics by telephone, requesting to be seen. Clinic and patient characteristics associated with the offer of an appointment within 48 hours were examined using unadjusted and UK country and patient gender adjusted multivariable logistic regression analyses. In March 2015, a convenience sample (one in four) of clinics was visited by researchers with the same clinical symptoms. Ability to achieve a same-day consultation and waiting time were assessed.
  
  
  
  In 2015, 90.8% of clinics offered symptomatic 'patients' an appointment within 48 hours when contacted by telephone, compared with 95.5% in 2014 (aOR=0.46 (0.26 to 0.83); p<0.01). The decline was greatest in women (96.0% to 90.1%; p<0.05), and clinics in England (96.2% to 90.7%; p<0.01). For asymptomatic patients, the proportion offered an appointment within 48 hours increased from 50.7% in 2014 to 74.5% in 2015 (aOR=3.06 (2.23 to 4.22); p<0.001), and in both men (58.2% to 90.8%; p<0.001) and women (49.0% to 59.6%; p<0.01). In adjusted analysis, asymptomatic women were significantly less likely to be offered an appointment than asymptomatic men (aOR=0.33 (0.23 to 0.45); p value<0.001). 95% of clinics were able to see symptomatic patients attending in person.
  
  
  
  Access to GUM services has worsened for those with symptoms suggestive of an acute STI and is significantly poorer for asymptomatic women. This evidence may support the reintroduction of process targets.
authors.affiliation: Department of Sexual Health, Solent NHS Trust, Royal South Hants Hospital, Southampton, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Foley
authors.affiliation: Department of HIV and STIs, Public Health England, London, UK.
authors.forename: Martina
authors.initials: M
authors.lastname: Furegato
authors.affiliation: Department of HIV and STIs, Public Health England, London, UK.
authors.forename: Gwenda
authors.identifier: 0000-0003-2090-7702
authors.initials: G
authors.lastname: Hughes
authors.affiliation: Southampton University School of Medicine, Southampton, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Board
authors.affiliation: Southampton University School of Medicine, Southampton, UK.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Hayden
authors.affiliation: Southampton University School of Medicine, Southampton, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Prescott
authors.affiliation: Southampton University School of Medicine, Southampton, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Shone
authors.affiliation: Solent NHS Trust, Southampton University School of Medicine, Southampton, UK.
authors.forename: Rajul
authors.initials: R
authors.lastname: Patel
mesh_terms: D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D003267:Contraception / Q000706:statistics & numerical data; D057210:Delayed Diagnosis / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012017:Referral and Consultation; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology; D012959:Socioeconomic Factors; D013689:Telephone; D006113:United Kingdom / Q000453:epidemiology; D014686:Venereology / Q000458:organization & administration / Q000592:standards
keywords: CLINICAL STI CARE; GENITOURINARY MEDICINE SERVICES; INFECTION CONTROL