Sexual Healthcare-Where to Go?

June 24, 2019

Patients seeking sexual health care more likely to visit emergency rooms despite clinics being located closer to home, study says

Gonorrhea and chlamydia infections are prevalent here in St. Louis and across the county, and left untreated can result in serious complications such as infertility and pelvic inflammatory disease. These infections are transmitted through sexual contact, and can be diagnosed at a clinic, doctor’s office, or emergency department (ED). For many reasons, including stigma and access, sexually transmitted diseases (STDs) present a public health challenge. As most people don’t experience symptoms, public awareness is especially important.

The rate of people seeking sexual health care in EDs is rising, and outpacing visits for other concerns. EDs are not as well equipped as clinics to provide complete sexual health care including specialized care, prevention messaging, expedited partner therapy, and follow up care for test results or providing treatment. It can also be difficult to disseminate current testing and treatment protocols for specific sub-populations, like pregnant women, to all ED providers and staff. The ED is, after all, designed to treat emergencies.

Led by Institute for Public Health Faculty Scholar, Dr. Hilary Reno, a team of physician-researchers and public health staff have been analyzing visits made to four local EDs* for sexual health care from 2010 – 2016. They have documented a high volume of testing done in each emergency department, as well as high rates of infection.

In their most recent paper, published this month in the journal Sexually Transmitted Disease, Reno’s team designed a study that would answer this question: how many people who visited the ED for gonorrhea or chlamydia testing lived closer to a clinic that was, at the time of their ED visit, free, open, and had walk-in availability? To do this they geocoded—or placed on a map—the self-reported home addresses of patients in their dataset, as well as the locations of the EDs and clinics offering STD testing in the area. They then calculated the distance from each patient’s home to the ED they visited as well as to the closest clinic.

Scholars
Assistant Professor, Divisions of Infectious Diseases and Hospitalist Medicine, School of Medicine

They found that 46% of urban patients lived closer to a free, open, walk in clinic than the ED they visited while 26% of suburban patients did. Additionally they found that half of all patients in the study lived closer to the St. Louis County Sexual Health Clinic, the only traditional STD clinic in the region, than they did to the ED they visited.

“We need to listen to patients,” says primary research investigator, Dr. Hilary Reno. “The fact that more than 50% of patients in our study are getting tested at ERs rather than at a traditional STD clinic closer to where they live, astounds me. Listening to WHY they’re making the healthcare decisions they’re making, what their exact needs are and combining this with effective public marketing campaigns that clearly communicate where the clinics are located and what they provide, is key to offering effective STD prevention outreach and healthcare.”

According to previous studies, people choose the ED for sexual health care for several reasons: it’s their primary source of care, it offers 24-hour access, or it provides anonymity. In order to improve current sexual health services for St. Louisans, a crucial next step for the study team will be to understand the reasons people select the ED over available clinics and then use that information to improve sexual health care for patients.

*Barnes Jewish Hospital, St. Louis Children’s Hospital, Christian Northeast, and Christian Northwest