STI initiative: Improving testing for sexually transmitted infections in women

Abstract

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.

Keywords: general practice; healthcare quality improvement; quality improvement; women’s health.

Figure 1

Project run charts. (A) Sexually transmitted infection (STI) testing rate by individual clinic, (B) STI testing rate for all clinics combined, (C) STI testing rate for all clinics combined—women aged 16–29 years. (D) Urinary tract infection (UTI) testing rate for all clinics combined. In each run chart, retrospective, project average and target rates are indicated with dashed lines.

Figure 2

Comparison of preproject and periproject testing and detection rates for sexually transmitted infections (STIs). GU, genitourinary.