Making it easier to get treated for Sexually Transmitted Infections (STIs)
Project lead: Dr Karla Blee, Consultant sexual Health and HIV (Central)
Rory Wilkinson, Head Pharmacy Primary Care and community Services (Central)
Tiffiny Lewandowski, North Denbighshire Cluster prescribing Support Pharmacy Technician
Kelly Andrews, Research Facilitator
Betsi Cadwaladr University Health Board
Background
Early treatment of STIs provides symptom relief and reduces the risk of developing complications and onward transmission.
STIs disproportionately affects young people, the socio-economically disadvantaged and vulnerable groups. These individuals often find it hardest to attend clinic and Covid has made this more challenging with fewer clinical sites operating, individuals not being able to rely on friends or family for transport and concerns about public transport.
Our traditional pathway meant 30% had to wait 3 or more days to receive treatment, travel on average 9 miles to clinic, taking 15minutes by car or 56 minute by public transport.
Project Aims
Primary Aim
To make getting treated for STIs easier
By moving care closer to home by using community pharmacies to dispense the medication.
Secondary aims
Create capacity to provide care for more serious healthcare needs
Appointments used for collection of medication can be utilised for specialist sexual health services that cannot be met elsewhere in the healthcare system.
Improve system inefficiencies
Reduce number of patients redirected to pharmacy to use common aliments scheme after a consultation with us.
How does it fit prudent healthcare?
- The new pathway was in response to patients asking us if they could collect their medication from a community pharmacy.
- Those who test positive for a STI have the greatest sexual health need.
The new pathway:
- Reduces travel to clinic and therefore potential exposure to Covid 19.
- Reduces time to treatment, and therefore harm from complications and transmission.
- Improves antimicrobial stewardship with reduced risk of future antimicrobial resistance (clinicians more likely to await results if reassured that the patient will be able to easily access treatment).
- Utilising collection appointments for other sexual health needs helps the service to meet standards of care around access and time from testing to treatment.
Challenges
There is no legal system for electronic prescribing or transfer of prescriptions. We have adopted a similar pathway to out of hours GPs to overcome this.
The new pathway is more time-consuming for the clinician. This has restricted its use to those who require urgent treatment. To make it as efficient as possible our nursing team will become independent prescribers.
A case where a patient did not collect their medication has identified a post Covid restructuring gap in our service for STI management follow-up which has prompted reallocation of protected time, benefiting all patients regardless of which treatment pathway used.
Key Outcomes
- 100% of patients were able to collect their medication on the same day as the telephone consultation.
- Collecting from a community pharmacy reduced the average travel distance by 8 miles (75% reduction), car journey time by 11 minutes (58% reduction), or 40min by public transport (63% reduction).
- 63% reported that the times to collect the medication at the community pharmacy were more convenient, 16% reported it was easier to get to then clinic, and 21% reported that they would not be able to physically get to the clinic to obtain their treatment.
- Our GUM specialist nurses can provide services to an extra 2-3 patients per week (equating to 5-8% of capacity), whose needs cannot be met elsewhere in the healthcare system.
- We have not achieved reducing system inefficiencies due to the time it takes to arrange a digital transfer process. If a patients need can be met by the common aliments scheme, or similar, we continue to redirect to pharmacy without the sexual health team prescribing. We are opting only to use the digital transfer pathway if the patient requires the medication urgently, if they do not require it urgently we make arrangements to post the prescription to them directly.
Patient Feedback
Next Steps
- Develop our nursing team to become independent prescribers.
- Engage with West and East Areas about adopting this pathway across North Wales (currently only in Conwy and Denbighshire).
- Facilitate a cultural change where dispensing of medication to meet sexual and reproductive health needs by community pharmacy is the norm.
- Engage with community pharmacies to help further transform dispensing of medication related to those with sexual health needs by expanding the medication available eg. Pre-exposure prophylaxis for HIV.
- Influence national decision makers about inclusion of sexual health as stakeholders in electronic prescribing and electronic transfer of prescriptions in Wales.
Our Exemplar Experience
Fantastic support and networking opportunities, helping to build and retain momentum to successfully transform clinical care during this challenging time.