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Alahmar A, AlMousa M, Benlamri R. Automated clinical pathway standardization using SNOMED CT- based semantic relatedness. Digit Health 2022; 8:20552076221089796. [PMID: 35392252 PMCID: PMC8980435 DOI: 10.1177/20552076221089796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
The increasing number of patients and heavy workload drive health care institutions to search for efficient and cost-effective methods to deliver optimal care. Clinical pathways are promising care plans that proved to be efficient in reducing costs and optimizing resource usage. However, most clinical pathways are circulated in paper-based formats. Clinical pathway computerization is an emerging research field that aims to integrate clinical pathways with health information systems. A key process in clinical pathway computerization is the standardization of clinical pathway terminology to comply with digital terminology systems. Since clinical pathways include sensitive medical terms, clinical pathway standardization is performed manually and is difficult to automate using machines. The objective of this research is to introduce automation to clinical pathway standardization. The proposed approach utilizes a semantic score-based algorithm that automates the search for SNOMED CT terms. The algorithm was implemented in a software system with a graphical user interface component that physicians can use to standardize clinical pathways by searching for and comparing relevant SNOMED CT retrieved automatically by the algorithm. The system has been tested and validated on SNOMED CT ontology. The experimental results show that the system reached a maximum search space reduction of 98.9% within any single iteration of the algorithm and an overall average of 71.3%. The system enables physicians to locate the proper terms precisely, quickly, and more efficiently. This is demonstrated using case studies, and the results show that human-guided automation is a promising methodology in the field of clinical pathway standardization and computerization.
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Affiliation(s)
- Ayman Alahmar
- Department of Software Engineering, Lakehead University, Thunder Bay, Ontario, Canada
| | - Mohannad AlMousa
- Department of Software Engineering, Lakehead University, Thunder Bay, Ontario, Canada
| | - Rachid Benlamri
- Department of Software Engineering, Lakehead University, Thunder Bay, Ontario, Canada
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2
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Nadarzynski T, Symonds Y, Carroll R, Gibbs J, Kidsley S, Graham CA. Acceptability of remote prescribing and postal delivery services for contraceptive pills and treatment of uncomplicated Chlamydia trachomatis. BMJ SEXUAL & REPRODUCTIVE HEALTH 2021; 47:185-192. [PMID: 33214195 DOI: 10.1136/bmjsrh-2020-200687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/23/2020] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES The digitalisation of sexual and reproductive health (SRH) services offers valuable opportunities to deliver contraceptive pills and chlamydia treatment by post. We aimed to examine the acceptability of remote prescribing and 'medication-by-post' in SRH. STUDY DESIGN An online survey assessing attitudes towards remote management was distributed in three UK SRH clinics and via an integrated sexually transmitted infection (STI) postal self-sampling service. Logistic regressions were performed to identify potential correlates. RESULTS There were 1281 participants (74% female and 49% <25 years old). Some 8% of participants reported having received medication via post and 83% were willing to receive chlamydia treatment and contraceptive pills by post. Lower acceptability was observed among participants who were: >45 years old (OR 0.43 (95% CI 0.23-0.81)), screened for STIs less than once annually (OR 0.63 (0.42-0.93)), concerned about confidentiality (OR 0.21 (0.90-0.50)), concerned about absence during delivery (OR 0.09 (0.02-0.32)) or unwilling to provide blood pressure readings (OR 0.22 (0.04-0.97)). Higher acceptability was observed among participants who reported: previously receiving medication by post (OR 4.63 (1.44-14.8)), preference for home delivery over clinic collection (OR 24.1 (11.1-51.9)), preference for home STI testing (OR 10.3 (6.16-17.4)), ability to communicate with health advisors (OR 4.01 (1.03-15.6)) and willingness to: register their real name (OR 3.09 (1.43-10.6)), complete online health questionnaires (OR 3.09 (1.43-10.6)) and use generic contraceptive pills (OR 2.88 (1.21-6.83)). CONCLUSIONS Postal treatment and entering information online to allow remote prescribing were acceptable methods for SRH services and should be considered alongside medication collection in pharmacies. These methods could be particularly useful for patients facing barriers in accessing SRH. The cost-effectiveness and implementation of these novel methods of service delivery should be further investigated.
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Affiliation(s)
| | | | | | - Jo Gibbs
- University College London, London, UK
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3
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Masya L, Shepherd HL, Butow P, Geerligs L, Allison KC, Dolan C, Prest G, Shaw J. Impact of Individual, Organizational, and Technological Factors on the Implementation of an Online Portal to Support a Clinical Pathway Addressing Psycho-Oncology Care: Mixed Methods Study. JMIR Hum Factors 2021; 8:e26390. [PMID: 33851926 PMCID: PMC8082382 DOI: 10.2196/26390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/08/2021] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Clinical pathways (CPs) can improve patient outcomes but can be complex to implement. Technologies, such as clinical decision support (CDS) tools, can facilitate their use, but require end-user testing in clinical settings. Objective This study applied the Technology Acceptance Model to evaluate the individual, organizational, and technological contexts impacting application of a portal to facilitate a CP for anxiety and depression (the ADAPT Portal) in a metropolitan cancer service. The ADAPT Portal triggers patient screening on patient reported outcomes, alerts staff to high scores, recommends evidence-based management, and triggers review and rescreening at set intervals. Methods Quantitative and qualitative data on portal activity, data accuracy, and health service staff perspectives were collected. Quantitative data were analyzed descriptively, and thematic analysis was applied to qualitative data. Results Overall, 15 (100% of those invited) health service staff agreed to be interviewed. During the pilot, 73 users (36 health service staff members and 37 patients) were registered on the ADAPT Portal. Of the 37 patients registered, 16 (43%) completed screening at least once, with seven screening positive and triaged appropriately. In total, 34 support requests were lodged, resulting in 17 portal enhancements (technical issues). Health service staff considered the ADAPT Portal easy to use and useful; however, some deemed it unnecessary or burdensome (individual issues), particularly in a busy cancer service (organizational issues). Conclusions User testing of a CDS to facilitate screening and assessment of anxiety and depression in cancer patients highlighted some technological issues in implementing the ADAPT CDS, resulting in 17 enhancements. Our results highlight the importance of obtaining health service staff feedback when piloting specialized CDS tools and addressing contextual factors when implementing them.
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Affiliation(s)
- Lindy Masya
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Sydney Local Health District, Camperdown, Australia
| | - Heather L Shepherd
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Phyllis Butow
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
| | - Liesbeth Geerligs
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | - Karen C Allison
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia
| | | | - Gabrielle Prest
- Australian College of Nursing, Sydney, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | | | - Joanne Shaw
- Psycho-Oncology Co-operative Research Group, School of Psychology, The University of Sydney, Sydney, Australia.,Centre for Medical Psychology and Evidence-based Decision-Making, School of Psychology, The University of Sydney, Sydney, Australia
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Mapp F, Wellings K, Mercer CH, Mitchell K, Tanton C, Clifton S, Datta J, Field N, Palmer MJ, Hickson F. Help-seeking for genitourinary symptoms: a mixed methods study from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Open 2019; 9:e030612. [PMID: 31666264 PMCID: PMC6830646 DOI: 10.1136/bmjopen-2019-030612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Quantify non-attendance at sexual health clinics and explore help-seeking strategies for genitourinary symptoms. DESIGN Sequential mixed methods using survey data and semistructured interviews. SETTING General population in Britain. PARTICIPANTS 1403 participants (1182 women) from Britain's Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; undertaken 2010-2012), aged 16-44 years who experienced specific genitourinary symptoms (past 4 weeks), of whom 27 (16 women) who reported they had never attended a sexual health clinic also participated in semistructured interviews, conducted May 2014-March 2015. PRIMARY AND SECONDARY OUTCOME MEASURES From survey data, non-attendance at sexual health clinic (past year) and preferred service for STI care; semistructured interview domains were STI social representations, symptom experiences, help-seeking responses and STI stigma. RESULTS Most women (85.9% (95% CI 83.7 to 87.9)) and men (87.6% (95% CI 82.3 to 91.5)) who reported genitourinary symptoms in Natsal-3 had not attended a sexual health clinic in the past year. Around half of these participants cited general practice (GP) as their preferred hypothetical service for STI care (women: 58.5% (95% CI 55.2% to 61.6%); men: 54.3% (95% CI 47.1% to 61.3%)). Semistructured interviews elucidated four main responses to symptoms: not seeking healthcare, seeking information to self-diagnose and self-treat, seeking care at non-specialist services and seeking care at sexual health clinics. Collectively, responses suggested individuals sought to gain control over their symptoms, and they prioritised emotional reassurance over accessing medical expertise. Integrating survey and interview data strengthened the evidence that participants preferred their general practitioner for STI care and extended understanding of help-seeking strategies. CONCLUSIONS Help-seeking is important to access appropriate healthcare for genitourinary symptoms. Most participants did not attend a sexual health clinic but sought help from other sources. This study supports current service provision options in Britain, facilitating individual autonomy about where to seek help.
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Affiliation(s)
- Fiona Mapp
- Institute for Global Health, University College London, London, UK
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Kaye Wellings
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Kirstin Mitchell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, Glasgow, UK
| | - Clare Tanton
- Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Soazig Clifton
- Institute for Global Health, University College London, London, UK
| | - Jessica Datta
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Nigel Field
- Institute for Global Health, University College London, London, UK
| | - Melissa J Palmer
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Ford Hickson
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
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Abstract
PURPOSE OF REVIEW Novel technologies, such as high-definition cameras, encryption software, electronic stethoscopes, microfluidic diagnostic systems, and widely available broadband Internet have expanded the potential for telemedicine. This narrative review presents current and future uses of telemedicine in the prevention, diagnosis, treatment, stewardship, and management of infectious disease. RECENT FINDINGS Beginning in the 1990s, early approaches to telemedicine in infectious disease focused largely on treatment of HIV/AIDS, hepatitis C, and tuberculosis. However, recent innovations allow for targeting of additional diseases and in increasingly remote settings. Telemedicine allows virtual visits between patients in the home and remote providers, permitting outpatient management of complex conditions, such as post-surgical site monitoring, and non-urgent infectious maladies, such as uncomplicated urinary tract infection. Remote provider education by videoconference and integrated clinical decision support tools create avenues to improve inpatient care, including antimicrobial stewardship. Technological strides from miniaturization of diagnostic tests to robotic telepresence physical exams improve access to infectious disease care in isolated and infrastructure-poor environments, from cargo ships to other resource-limited settings. Telemedicine in the field of infectious disease is rapidly expanding in clinical, technological, geographical, and human capacity. Recent innovations narrow gaps in access to care for populations traditionally underserved, stigmatized, isolated by remote geography, or lacking technological infrastructure. Current and future approaches will transform inpatient, outpatient, and remote care.
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Taking connected mobile-health diagnostics of infectious diseases to the field. Nature 2019; 566:467-474. [PMID: 30814711 DOI: 10.1038/s41586-019-0956-2] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 08/08/2018] [Indexed: 11/08/2022]
Abstract
Mobile health, or 'mHealth', is the application of mobile devices, their components and related technologies to healthcare. It is already improving patients' access to treatment and advice. Now, in combination with internet-connected diagnostic devices, it offers novel ways to diagnose, track and control infectious diseases and to improve the efficiency of the health system. Here we examine the promise of these technologies and discuss the challenges in realizing their potential to increase patients' access to testing, aid in their treatment and improve the capability of public health authorities to monitor outbreaks, implement response strategies and assess the impact of interventions across the world.
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Gibbs J, Aicken CRH, Sutcliffe LJ, Gkatzidou V, Tickle LJ, Hone K, Sadiq ST, Sonnenberg P, Estcourt CS. Mixed-methods evaluation of a novel online STI results service. Sex Transm Infect 2018; 94:622-624. [PMID: 29326179 PMCID: PMC6288705 DOI: 10.1136/sextrans-2017-053318] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/02/2017] [Accepted: 12/10/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives Evidence on optimal methods for providing STI test results is lacking. We evaluated an online results service, developed as part of an eSexual Health Clinic (eSHC). Methods We evaluated the online results service using a mixed-methods approach within large exploratory studies of the eSHC. Participants were chlamydia- positive and negative users of online postal self-sampling services in six National Chlamydia Screening Programme (NCSP) areas and chlamydia-positive patients from two genitourinary medicine (GUM) clinics between 21 July 2014 and 13 March 2015. Participants received a discreetly worded National Health Service ’NHS no-reply’ text message (SMS) informing them that their test results were ready and providing a weblink to a secure website. Participants logged in with their date of birth and mobile telephone or clinic number. Chlamydia-positive patients were offered online management. All interactions with the eSHC system were automatically logged and their timing recorded. Post-treatment, a service evaluation survey (n=152) and qualitative interviews (n=36) were conducted by telephone. Chlamydia-negative patients were offered a short online survey (n=274). Data were integrated. Results 92% (134/146) of NCSP chlamydia-positive patients, 82% (161/197) of GUM chlamydia-positive patients and 89% (1776/1997) of NCSP chlamydia-negative participants accessed test results within 7 days. 91% of chlamydia-positive patients were happy with the results service; 64% of those who had tested previously found the results service better or much better than previous experiences. 90% of chlamydia-negative survey participants agreed they would be happy to receive results this way in the future. Interviewees described accessing results with ease and appreciated the privacy and control the two-step process gave them. Conclusion A discreet SMS to alert users/patients that results are available, followed by provision of results via a secure website, was highly acceptable, irrespective of test result and testing history. The eSHC results service afforded users privacy and control over when they viewed results without compromising access.
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Affiliation(s)
- Jo Gibbs
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Catherine R H Aicken
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, UK
| | - Lorna J Sutcliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UK
| | - Laura J Tickle
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UK
| | - S Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Pam Sonnenberg
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, UK
| | - Claudia S Estcourt
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
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8
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Abstract
PURPOSE OF REVIEW HIV prevention and care is changing rapidly; guideline revisions and programmatic scale-up require innovative approaches to in-service training and care extension to improve provider practice and care access. We assessed recent (≤12 months) peer-reviewed publications on electronic health (eHealth), telemedicine, and other innovative provider-targeted interventions for HIV-related care. RECENT FINDINGS Key developments included systems merging electronic medical records (EMR) with provider clinical decision aids to prompt action, demonstration eHealth, and telemedicine projects, reviews or descriptions of technology to improve connectivity in lower resource settings, and a few trials on provider-centered interventions. Most publications were program reports and few data were available regarding efficacy of eHealth interventions for providers on patient HIV-related outcomes, notably identification and management of antiretroviral treatment failure in Kenya. Better evidence is needed for strategies to train providers and care extenders with the goal to improve impact of HIV prevention and care interventions. SUMMARY Rapid technology introduction and expansion may change the paradigm for improving provider knowledge and practice. Although new, the developments are promising for HIV provider-targeted eHealth and innovations for traditional training. More rigorous testing with randomized trials is needed to demonstrate impact on services for people living with HIV.
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Aicken CRH, Sutcliffe LJ, Gibbs J, Tickle LJ, Hone K, Harding-Esch EM, Mercer CH, Sonnenberg P, Sadiq ST, Estcourt CS, Shahmanesh M. Using the eSexual Health Clinic to access chlamydia treatment and care via the internet: a qualitative interview study. Sex Transm Infect 2017; 94:241-247. [PMID: 28988193 PMCID: PMC5969326 DOI: 10.1136/sextrans-2017-053227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022] Open
Abstract
Objective We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention. Methods Within exploratory studies of the eSHC (2014–2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18–35, 20 female, 16 male). Thematic analysis was conducted. Results Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic access. They described completing the online consultation promptly, discreetly and with ease. The information provided online was considered comprehensive, reassuring and helpful, but some overlooked it in their haste to obtain treatment. Participants generally described being able to collect treatment from pharmacies discreetly and promptly, but for some, poor awareness of the eSHC by pharmacy staff undermined their ability to do this. Those unsuitable for remote management, who were directed to clinic, described frustration and concern about health implications and clinic attendance. However, the helpline was a highly valued source of information, assistance and support. Conclusion The eSHC is a promising adjunct to traditional care. Its users have high expectations for convenience, speed and privacy, which may be compromised when transitioning from online to face-to-face elements of the eSHC. Managing expectations and improving implementation of the pharmacy process, could improve their experiences. Positive views on the helpline provide further support for embedding this ehealth intervention within a specialist clinical service.
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Affiliation(s)
- Catherine R H Aicken
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
| | - Lorna J Sutcliffe
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
| | - Jo Gibbs
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK.,Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
| | - Laura J Tickle
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University, London, UK
| | - Emma M Harding-Esch
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK.,HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
| | - S Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Claudia S Estcourt
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maryam Shahmanesh
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
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Estcourt CS, Gibbs J, Sutcliffe LJ, Gkatzidou V, Tickle L, Hone K, Aicken C, Lowndes CM, Harding-Esch EM, Eaton S, Oakeshott P, Szczepura A, Ashcroft RE, Copas A, Nettleship A, Sadiq ST, Sonnenberg P. The eSexual Health Clinic system for management, prevention, and control of sexually transmitted infections: exploratory studies in people testing for Chlamydia trachomatis. LANCET PUBLIC HEALTH 2017; 2:e182-e190. [PMID: 29253450 DOI: 10.1016/s2468-2667(17)30034-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/04/2017] [Accepted: 02/03/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Self-directed and internet-based care are key elements of eHealth agendas. We developed a complex online clinical and public health intervention, the eSexual Health Clinic (eSHC), in which patients with genital chlamydia are diagnosed and medically managed via an automated online clinical consultation, leading to antibiotic collection from a pharmacy. Partner notification, health promotion, and capture of surveillance data are integral aspects of the eSHC. We aimed to assess the safety and feasibility of the eSHC as an alternative to routine care in non-randomised, exploratory proof-of-concept studies. METHODS Participants were untreated patients with chlamydia from genitourinary medicine clinics, untreated patients with chlamydia from six areas in England in the National Chlamydia Screening Programme's (NCSP) online postal testing service, or patients without chlamydia tested in the same six NCSP areas. All participants were aged 16 years or older. The primary outcome was the proportion of patients with chlamydia who consented to the online chlamydia pathway who then received appropriate clinical management either exclusively through online treatment or via a combination of online management and face-to-face care. We captured adverse treatment outcomes. FINDINGS Between July 21, 2014, and March 13, 2015, 2340 people used the eSHC. Of 197 eligible patients from genitourinary medicine clinics, 161 accessed results online. Of the 116 who consented to be included in the study, 112 (97%, 95% CI 91-99) received treatment, and 74 of those were treated exclusively online. Of the 146 eligible NCSP patients, 134 accessed their results online, and 105 consented to be included. 93 (89%, 95% CI 81-94) received treatment, and 60 were treated exclusively online. In both groups, median time to collection of treatment was within 1 day of receiving their diagnosis. 1776 (89%) of 1936 NCSP patients without chlamydia accessed results online. No adverse events were recorded. INTERPRETATION The eSHC is safe and feasible for management of patients with chlamydia, with preliminary evidence of similar treatment outcomes to those in traditional services. This innovative model could help to address growing clinical and public health needs. A definitive trial is needed to assess the efficacy, cost-effectiveness, and public health impact of this intervention. FUNDING UK Clinical Research Collaboration.
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Affiliation(s)
- Claudia S Estcourt
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK; Research Department of Infection & Population Health, University College London, London, UK; School of Health & Life Science, Glasgow Caledonian University, Glasgow, UK.
| | - Jo Gibbs
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK; Research Department of Infection & Population Health, University College London, London, UK
| | - Lorna J Sutcliffe
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UK
| | - Laura Tickle
- Blizard Institute, Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UK
| | - Catherine Aicken
- Research Department of Infection & Population Health, University College London, London, UK
| | | | | | - Sue Eaton
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George's, University of London, London, UK
| | - Ala Szczepura
- Centre for Technology Enabled Health Research, Faculty of Health & Life Sciences, Coventry University, Coventry, UK
| | | | - Andrew Copas
- Research Department of Infection & Population Health, University College London, London, UK
| | | | - S Tariq Sadiq
- Institute for Infection and Immunity, St George's, University of London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, London, UK
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