Patients often perceive no risk if they delay attending STI clinics

Over a third of patients are declining appointments that genitourinary medicine clinics offer within the UK target time of 48 hours, a study published in the September edition of the International Journal of STD and AIDS suggests. Work commitments were the most common reason for appointments being declined.

The presence of symptoms did not affect the likelihood of patients turning down an appointment within 48 hours. The investigators also found that the majority of patients declining prompt appointments did not perceive any health risks from delaying the diagnosis and treatment of sexually transmitted infections.

“There are certainly a cohort of patients who have symptoms of an STI but do not see this as a risk to their health if assessment and treatment are delayed”, write the study’s authors.

Prompt treatment for individuals with sexually transmitted infections helps avoid illness and discomfort in the patient and also helps prevent the onward transmission of infections.

It is a UK government target that all patients seeking the services of sexual health clinics should be offered an appointment within 48 hours of requesting one. An additional target is that 95% of all individuals should be seen within 48 hours of making their appointment, although some clinicians have questioned if this is necessary.

Investigators from the Department of Sexual Health at the Countess of Chester Hospital, Chester, a large genitourinary medicine clinic in north-west England, designed a study to see if patient choice to be seen within 48 hours was related to the presence of symptoms. They also wished to ascertain the perceptions of patients regarding the health consequences of untreated sexually transmitted infections.

Two groups of patients were included in the study. The first comprised 110 individuals who completed questionnaires at the clinic. The second involved 138 patients who were contacted by telephone and asked questions about their decision to accept or decline an appointment within 48 hours.

Records showed that all individuals contacting the clinic were offered an appointment within 48 hours. Of the individuals interviewed whilst attending the clinic, 16% recalled declining such an appointment.

Work commitments were the most common reason for individuals delaying their clinic appointment (75%).

A total of 37% of individuals interviewed by telephone declined an appointment within 48 hours. Symptoms were reported by 45% of those declining a prompt appointment, and work commitments were once again the most common reason (87%) for deferring attendance at the clinic.

The investigators then combined the results of the two surveys. They found that individuals accepting an appointment within 48 hours were significantly more likely than the patients declining an appointment to believe that delaying their attendance at the clinic could involve health risks (41/80 vs. 9/60, p < 0.0001).

“Our…data suggest that 37% of patients preferred not to accept the offer of an appointment to be seen within 48 hours. This is high”, comment the investigators. They add, “patients wish to be able to choose an appointment that suits them and are happy with this, even if it is more than 48 hours from booking.”

“We should be providing information as to why being seen within 48 hours may be important”, conclude the investigators, adding “our findings represent a clear justification for increased public awareness of the dangers of sexually transmitted infections.”

Although they recognise the importance of patient choice regarding the timing of appointments, the investigators stress that it is important that “their choice is an informed one.”