Mercer Catherine H, Sutcliffe Lorna, Johnson Anne M, White Peter J, Brook Gary, Ross Jonathan D C, Dhar Jyoti, Horner Paddy, Keane Frances, Jungmann Eva, Sweeney John, Kinghorn George, Garnett Geoff G, Stephenson Judith M, Cassell Jackie A
Centre for Sexual Health and HIV Research, University College London, Mortimer Market Centre, London, UK.
Sex Transm Infect. 2007 Aug;83(5):400-5. doi: 10.1136/sti.2006.024554. Epub 2007 May 2.
To quantify the contribution of patient delay, provider delay, and diversion between services to delayed access to genitourinary medicine (GUM) clinics. To describe the factors associated with delay, and their contribution to STI transmission.
Cross-sectional survey of 3184 consecutive new patients attending four GUM clinics purposively selected from across England to represent different types of population. Patients completed a short written questionnaire that collected data on sociodemographics, access, and health-seeking behaviour. Questionnaires were then linked to routinely collected individual-level demographic and diagnostic data.
Patient delay is a median of 7 days, and does not vary by demographic or social characteristics, or by clinic. However, attendance at a walk-in appointment was associated with a marked reduction in patient delay and provider delay. Among symptomatics, 44.8% of men and 58.0% of women continued to have sex while awaiting treatment, with 7.0% reporting sex with >1 partner; 4.2% of symptomatic patients reported sex without using condoms with new partner(s) since their symptoms had begun. Approximately 25% of all patients had already sought or received care in general practice, and these patients experienced greater provider delay.
Walk-in services are associated with a reduction in patient and provider delay, and should be available to all populations. Patients attending primary care require clear care pathways when referred on to GUM clinics. Health promotion should encourage symptomatic patients to seek care quickly, and to avoid sexual contact before treatment.
量化患者延误、医疗服务提供者延误以及不同服务间转诊导致的延误对延迟就诊泌尿生殖医学（GUM）诊所的影响。描述与延误相关的因素及其对性传播感染传播的影响。
对从英格兰各地有目的地选取的四家GUM诊所的3184名连续就诊的新患者进行横断面调查，以代表不同类型的人群。患者完成一份简短的书面问卷，收集社会人口统计学、就诊机会和就医行为的数据。然后将问卷与常规收集的个人层面的人口统计学和诊断数据相联系。
患者延误的中位数为7天，且不因人口统计学或社会特征或诊所而有所不同。然而，预约即看门诊与患者延误和医疗服务提供者延误的显著减少相关。在有症状的患者中，44.8%的男性和58.0%的女性在等待治疗期间仍有性行为，7.0%的人报告与一名以上性伴侣发生过性行为；4.2%有症状的患者报告自出现症状以来与新伴侣发生性行为时未使用避孕套。所有患者中约25%已经在全科医疗中寻求或接受过治疗，这些患者经历了更长的医疗服务提供者延误。
预约即看门诊服务与患者和医疗服务提供者延误的减少相关，应向所有人群提供。转诊至GUM诊所的初级保健患者需要明确的就医途径。健康促进应鼓励有症状的患者尽快寻求治疗，并在治疗前避免性接触。
