NEW YORK — Busy STD clinics may be able to offer “express visits” that provide disease screening only for asymptomatic patients without missing infected individuals.
Researchers with the New York City Department of Mental Health and Hygiene and the Centers for Disease Control and Prevention evaluated the impact of instituting routine express visits in nine of the city's free walk-in clinics. During an express visit, asymptomatic patients with no known contact with an STD case were given the option of skipping the physician visit and being screened for gonorrhea, chlamydia, syphilis, and HIV.
The use of express visits allowed the clinic staff to screen a large number of asymptomatic patients, resulted in better use of physician resources, allowed for the treatment of more patients who were positive for gonorrhea or chlamydia infections, and improved the time to treatment, according to the results of the study.
In 2006, the nine clinics conducted 18,421 physician visits and 6,064 express visits. The proportion of patients who presented with symptoms during the physician visit increased from 74% in 2005 to 86% in 2006. There also was a decrease in the time to treatment for those seen during a physician visit. The median time to treatment dropped from 14 days in 2005 to 10 days in 2006. The median time to treatment for those who underwent express visits in 2006 was 9 days.
The number of gonorrhea or chlamydia infections that were diagnosed during a physician visit increased following the establishment of express visits in 2006. The number of gonorrhea or chlamydia infections detected during physician visits rose from 2,043 in 2005 to 2,081 in 2006. There were also 536 cases diagnosed during express visits.
Express visits appear to work well for the “worried well” population, Jessica M. Borrelli, a research scientist in the bureau of STD control of the New York City Department of Mental Health and Hygiene, said in an interview. For example, individuals who come in because they have a new sexual partner can be screened for STDs without tying up physician time, she said. Ms. Borrelli presented the poster at a joint conference of the American Sexually Transmitted Diseases Association and the British Association for Sexual Health and HIV.
In 2005, the express visit option was conceived in an effort to deal with the increasing patient volume at New York City STD clinics. The following year, the express visit was introduced as a routine option. The researchers used clinic electronic medical records to compare patient data from September-December 2005—before express visits became routine—with patient data from September to December 2006—after the express visits were established.