Chadwick Ryan Christopher, McGregor Kathleen, Sneath Paula, Rempel Joshua, He Betty Li Qun, Brown Allison, Seifred Grant, McAuley John, Kamatovic Ralph John, Al-Husari Muhanad, Ahmed Salim, Bertolo Monica, Munkley Doug, Luterman Maynard
Michael G. DeGroote School of Medicine-Niagara Regional Campus, McMaster University, St. Catharines, Ontario, Canada.
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
BMJ Open Qual. 2018 Oct 15;7(4):e000461. doi: 10.1136/bmjoq-2018-000461. eCollection 2018.
Canadian urgent care and walk-in medical clinics provide health care for a population that may be poorly covered by traditional health care structures. Despite evidence suggesting that women with urinary complaints experience a high incidence of sexually transmitted infections (STIs), this population may be under-tested in this particular setting. The aim of this quality improvement initiative was to increase STI testing in women presenting with GU complaints. Implementation of an opt-out method of STI testing for women ages 16 and older was introduced at three walk-in clinics. Women presenting with GU complaints were given the opportunity to provide samples for both conventional urine culture and nucleic acid amplification testing (NAAT) for non-viral STIs. Patients received treatment according to standard of care and public health was notified as per local regulations. Testing rate and STI incidence was tracked via clinic electronic medical records (EMRs). Overall results were tracked using run charts and compared to historical data for the year prior to the start of the project. Over a 1 year period prior to this intervention, only 65 STI tests were performed in over 1100 GU complaints (5.5%). Six STIs were identified during this time. During the 36-week project period, testing increased to 45% of the patient population (320/707). The STI detected incidence increased from 0.51% to 1.4% in all women, and from 0.84% to 3.4% in women aged 16-29 years. An opt-out method was an effective intervention for increasing STI testing within the walk-in clinic setting. With optimisation, significant increases in testing rates can be obtained without substantially increasing clinic workload and at no economic cost to the clinic. As expected, detected incidence rates of STIs were higher than the recognised population prevalence.
加拿大的紧急护理诊所和无需预约的医疗诊所为那些可能未被传统医疗保健体系充分覆盖的人群提供医疗服务。尽管有证据表明，有泌尿问题的女性性传播感染（STIs）的发病率很高，但在这种特定环境下，这一人群可能接受检测的比例较低。这项质量改进计划的目的是增加对有泌尿生殖系统（GU）问题的女性进行性传播感染检测。在三家无需预约的诊所引入了针对16岁及以上女性的性传播感染检测的选择退出方法。有泌尿生殖系统问题的女性有机会提供样本进行传统尿培养和非病毒性传播感染的核酸扩增检测（NAAT）。患者按照护理标准接受治疗，并根据当地法规通知公共卫生部门。通过诊所电子病历（EMR）跟踪检测率和性传播感染发病率。使用运行图跟踪总体结果，并与项目开始前一年的历史数据进行比较。在这项干预措施实施前的1年时间里，在1100多例泌尿生殖系统问题中仅进行了65次性传播感染检测（5.5%）。在此期间发现了6例性传播感染。在为期36周的项目期间，检测率提高到患者人群的45%（320/707）。所有女性中性传播感染的检出率从0.51%上升到1.4%，16至29岁女性中从0.84%上升到3.4%。选择退出方法是在无需预约的诊所环境中增加性传播感染检测的有效干预措施。通过优化，可以在不大幅增加诊所工作量且诊所无需承担经济成本的情况下，显著提高检测率。正如预期的那样，性传播感染的检出率高于公认的人群患病率。
