Historic rates of sexually transmitted diseases (STDs) indicate that something about our response isn’t working. In fact, maybe even many things aren’t working. One thing is certain — not all clinical encounters are patient-centered. There are several elements that make up patient-centered care, including respect for patients’ preferences, encouraging patients’ involvement in their healthcare, and empowering patients to use risk reduction approaches that align with their needs and desires.
NACCHO’s HIV, STI, & Viral Hepatitis program supports the work of local health departments (LHDs) to provide patient-centered care in their STD clinics. Many of the tools and resources to strengthen patient-centered care focus on the patient-provider relationship, which is at the heart of most clinical encounters. Providers are encouraged to take a thorough sexual history and normalize discussions around sex; avoid making assumptions about patients’ identities, orientations, and behaviors; use sexual history to determine appropriate STD tests and anatomical sites; and provide prevention and risk reduction counseling. These practices are critical to destigmatizing sex and STDs and determining which anatomical sites should be tested, increasing the likelihood that infections are identified and treated.
But it is not required that the provider be the key to patient-centered care. The real key is to meet the patient “where they are” and provide them the services that they need in a way that serves them. In this vein, a new type of STD clinic visit that is gaining traction in the United States is the express visit. Express services, which refer to triage-based STD testing without a full clinical examination, have been implemented both domestically and globally to provide less resource-intensive services to patients at lower risk for STDs and with fewer other healthcare needs. In express services, asymptomatic patients are routed to less intensive clinical services. While express service models vary, there are a number of core elements seen across models:
- Triage to route patients to express or traditional provider visit
- No physical examination
- Patient self-collects specimens, including swabs and urine, while a nurse or phlebotomist collects serum
- Aided by technology/automation for triaging, faster lab turnaround times, and notification of results
- Reliance on diverse staffing to allow healthcare professionals to work at the top of their licenses
Express services have been shown to increase clinic capacity, reduce time to treatment, reduce visit time, and decrease visit cost, and therefore have the potential to increase access and testing while maximizing available resources.
It might seem as though express services, without the opportunity for the patient-provider relationship, are limited in their ability to be considered patient-centered. However, the express model puts the patient front and center, as it is designed to reduce wait time and visit time, limit uncomfortable and stigmatizing conversations through computer-assisted or electronic risk assessments, and prioritize confidentiality. Moreover, self-collection has been shown to increase the uptake of testing as it removes several barriers, such as shame, stigma, and confidentiality concerns.
Several stand-alone express clinics are being built in the U.S. to offer patients this type of visit based on feedback from priority communities. Evaluations of express services indicate that patients who use express clinics are satisfied with their experience, and patients from priority populations, such as adolescents, indicated that they were more likely to use express services than traditional provider visits.
Given sustained high rates of STDs, it is necessary that we rethink the way STI prevention and treatment is provided. In January 2018, NACCHO launched the STD Express Initiative, which aims to increase the capacity of STD clinics to offer express services that are responsive to patient, clinic, and community needs and advance STD prevention efforts. Through this Initiative, NACCHO is undertaking a number of activities to expand the evidence base for STD express services and increase the capacity of clinics to establish, scale-up, and evaluate STD express services. These efforts include working with STD clinics across the country to assess common motivations, challenges, and practices related to express services in order to synthesize express models and better understand their use.
All STD clinics are eligible to participate. Please sign up by filling out this form. Sign up for NACCHO’s HIV, STI, & Viral Hepatitis Digest to get the latest information and updates about NACCHO’s STD Express Initiative. Contact Samantha Ritter, Senior Program Analyst for HIV, STI, & Viral Hepatitis, at firstname.lastname@example.org with any questions.