Accessibility of genitourinary medicine clinics.

OBJECTIVES: to examine and compare the accessibility and acceptability of a range of genitourinary medicine (GUM) clinics. DESIGN: five GUM clinics representing different types of locations in the West Midlands Region were selected. All patients attending over the sampling period were included, with data collected by anonymous self completed questionnaire. RESULTS: 297 completed questionnaires were obtained from 360 attendees; 87.4% of attendees had taken 30 minutes or less to get to the clinic, and 66% had used public transport, with variations found between locations. The majority (72.5%) of attendees visited the clinics during their preferred part of the day. Examination of narrower time preferences showed that those wanting to visit in the evening were less likely to be seen during their preferred time than those wanting daytime visits (32% compared with 90%). Of the attendees 98.6% found clinic staff to be friendly and 97.5% did not feel they were being judged because of their sexual activities. The most common reasons for choosing a clinic were recommendation (38.2%) and proximity (36.4%). CONCLUSIONS: the clinics were generally found to be physically accessible, although clinic opening hours need to be reconsidered. Further work is needed on the acceptability of the service in relation to expectations.     

Workloads in genitourinary medicine clinics in England.

Work loads in venereal disease--sexually transmitted disease (STD)--genitourinary medicine (GUM) clinics have risen greatly in recent years. The increase in viral infections which are more difficult and time consuming to manage than those caused by bacteria and the higher expectations and demands of patients have combined to increase workloads more than the case figures indicate. This prompted the Department of Health and Social Security in 1988 to set up a survey of clinics in England with the following terms of reference: "To examine current and forecast workloads on GUM clinics, taking account of AIDS and other STDs, and to recommend any action which may need to be taken on manpower (including nursing manpower), training, resources and accommodation". The team concluded that the GUM service was ill equipped to meet the demands for its services, and made 36 recommendations. The priority recommendations included: the need to provide more resources; government ministers should give a lead in developing the service; all health districts should provide care for STD and HIV infection; all new patients should be seen on the day of presentation or failing that on the next occasion the clinic was open. Other recommendations included: location of all GUM clinics in the general outpatient department of general hospitals; accommodation of the same standard as other outpatient departments; review of the distribution of clinics; review of staffing levels and roles; and coordination of care of HIV infection. Many of these recommendations have already led to action including a lead from government ministers and provision of more funds. Many of the problems and recommendations will apply in other countries.     

Hepatitis B vaccination schedules in genitourinary medicine clinics.

OBJECTIVES: To compare two vaccination schedules in delivering hepatitis B vaccine to at-risk genitourinary medicine clinic attenders. SETTING: Genitourinary medicine clinic of St Thomas' Hospital, London, UK. METHODS: Two vaccination protocols were compared. Between January 1991 and December 1992, individuals had doses of recombinant hepatitis B vaccine at 0, 1 and 6 months (standard). From January until October 1993 doses of vaccine were administered at 0, 1 and 2 months (accelerated), following which timing of a booster dose was made on the basis of hepatitis B surface antibody (anti-HBs) assessment. Case notes were reviewed with regard to compliance rates and anti-HBs levels. RESULTS: Two hundred and fourteen individuals were included (standard 104, accelerated 110). Of the standard group 80.8% and 61.5% attended for the 2nd and 3rd doses respectively compared with 80.0% and 75.5% of the accelerated group (attendance for the 3rd dose chi 2 = 4.19, p < 0.05). For both of these groups compliance was significantly better in those who requested vaccination rather than being offered it opportunistically (chi 2 = 4.86, p < 0.05). Seroconversion rates were not significantly different between the two groups (87.5% versus 83.1%). A significantly higher proportion of the standard group, however, achieved anti-HBs levels greater than 100 i.u./l. CONCLUSIONS: Completion of hepatitis B vaccination was improved by changing to a 0, 1 and 2 month protocol. Levels of anti-HBs achieved in the accelerated group, however, were lower. If it is confirmed that maintaining anti-HBs levels is not important in retaining protection against hepatitis B then the accelerated schedule has clear advantage. If not, the advantages may be nullified by the need, in some, for an early booster.     

The choice of microscopes for use in genitourinary medicine clinics.

The current wide choice of microscopes and the use of the microscope as a diagnostic tool is discussed. The formation of images and the aberrations which occur with lenses and the ways in which these are corrected are described. The functions of eye pieces and illuminating systems are presented. The requirements for microscopes in every day use, research microscopes and portable microscopes are described, and suggestions made as to how these requirements may be fulfilled. Brief comments on the care and maintenance of microscopes are made, and a list of manufacturers and suppliers appended.     

Value of colposcopy in genitourinary departments.

During 18 months 237 colposcopies were performed on 227 patients in the department of genitourinary medicine, Sheffield. Histological evidence of cervical intraepithelial neoplasia was found in 118 patients (52%), of whom 104 (88%) were aged under 35, 93 (79%) under 30, and 64 (54%) under 25. Most were treated with local destructive treatment, only five (4%) requiring cone biopsy. Colposcopy in a genitourinary department has an important part to play in detecting cervical intraepithelial neoplasia, particularly in younger women. Early diagnosis may often facilitate using local destructive treatment, thereby reducing the numbers of patients needing cone biopsy.     

Guidance for the planning and design of genitourinary medicine clinics.

The number of patients attending genitourinary medicine (GUM) clinics in Britain has risen greatly in recent years. In contrast there have been very modest increases in staff and there are no data on accommodation or facilities. The Department of Health therefore set up a team to provide guidance on the planning and design of GUM clinics. After a survey the team concluded that GUM clinics in England were poorly and inappropriately accommodated. In their guidance they recommended that GUM clinics are sited in general outpatient departments (OPDs) of general hospitals; this improves patient care simplifying cross referral, consultation and other aspects of operational efficiency and convenience for patients, improves cost effectiveness and increases convenience for staff. Some facilities may be shared. Reception should be an attractive focal point and allow patients to be received and registered in privacy. Facilities for clinical examination are the central part of a clinic. Rooms which allow consultation and examination (CE) rooms of male and female patients maximise efficiency, flexibility and confidentiality. Sound attenuation is vital and decor should be attractive so inspiring confidence by producing a non-institutional atmosphere. An adequate number of CE rooms is essential and the waiting area should be sufficient for booked and walk in patients plus companions. There must be rooms for venepuncture, treatment and colposcopy. Interviewing rooms and offices are important, and there must be a secure health records store. A childrens play area and staff accommodation can be shared. An area for handling and simple investigation of patients' specimens is essential. This guidance should be interpreted flexibly. Though commissioned by the Department of Health for England, it is hoped that it will be useful for planning and designing genitourinary medicine clinics throughout Britain and in other countries.     

Access to genitourinary medicine clinics in the United Kingdom

OBJECTIVES: To assess the variability in time taken for a patient to be seen in a genitourinary (GUM) clinic in the United Kingdom having contacted that clinic by telephone and compare this with GUM physicians' expectations. METHODS: A postal questionnaire was sent to lead GUM physicians asking when they thought patients with two specific clinical scenarios would be seen in their clinics. Following this, healthcare personnel contacted individual units posing as patients with the same clinical scenarios and asked to be seen as soon as possible. RESULTS: 202/258 (78%) lead clinicians responded to the postal questionnaire. All clinics claimed to have procedures allowing patients with acute symptoms to be assessed urgently and estimated that such patients would be seen within 48 hours of the initial telephone contact. In 243 of 311 (78%) clinic contacts, the patient was invited to attend the clinic within 48 hours. For the remaining 68 contacts (22%) the patient could not be accommodated within 48 hours and, of these, 49 could not be seen for more than 1 week. CONCLUSIONS: No clinician estimated that patients with acute severe symptoms would be seen more than 48 hours after the initial telephone contact, but in reality, for 22% of the patient contacts this was the case. This study may well underestimate the difficulties the general public may have in accessing GUM services. We hypothesise that this situation could be ameliorated by establishing process standards and addressing issues of resource allocation.     

A comparison of HIV related advice in genitourinary medicine clinics with different histories.

OBJECTIVES: To examine attendees reported experiences of health advice provision in genitourinary (GUM) clinics with different histories. DESIGN: A self-completed anonymous questionnaire was distributed at five clinics in the West Midlands Region of the United Kingdom. RESULTS: 297 of the 360 attendees approached returned completed questionnaires; 89.5% reported receiving health advice, 86.4% found all of this easy to understand and 10.4% wanted more advice. However, 33.9% received no advice on either HIV or safer sex. Those attending new clinics, set up since the HIV pandemic, were more likely than those attending older clinics, to have understood the advice given, to have had advice on both HIV and safer sex, and less likely to have wanted more advice. Among those attending with a concern about HIV, 14% claimed to have received no advice on either HIV or safer sex; with no difference between old and new clinics. For those attending with reasons particularly relevant to receiving HIV related advice, but not with a concern about HIV, 40% claimed to have received neither HIV nor safer sex advice. In this sub-sample, those attending new clinics were more likely to have received advice on HIV as well as safer sex, and less likely to want more advice. CONCLUSIONS: The results indicate that the provision of advice needs to be reconsidered, particularly in older clinics.