Feasibility and acceptability of routine human immunodeficiency virus testing in general practice: your views.

Early diagnosis of human immunodeficiency virus (HIV) leads to a decreased morbidity and mortality. General practice offers an important window for earlier diagnosis. The British HIV Association produced guidelines in 2008 advocating an increase in HIV testing, with specific references to primary care. This study explores the awareness of, and opinions towards, these guidelines within general practice. An email questionnaire was sent to 191 general practitioners nationwide, in both areas of high and low HIV prevalence. A total of 80 doctors replied, giving a response rate of 42%. In all, 44% of the respondents were unaware of the guidelines and 89% felt comfortable discussing and carrying out an HIV test themselves; of the 11% that did not, all but one were from low prevalence areas (P = 0.037). Respondents felt that main barrier to HIV testing was patient acceptability. Having read the guidelines, 70% believed it would be feasible to follow them in practice. Those who disagreed felt that time implications were the most important reason not to adopt the guidelines. Almost half the respondents were not aware of the guidelines; having read them, the majority felt that implementation is feasible. This demonstrates the necessity for better dissemination of these guidelines. This study found that the main barrier to performing an HIV test was felt to be patient acceptance, a contradiction to findings from recent pilot studies.

Need for risk adjustment in adapting episode grouping software to Medicare data.

Episode grouper software offers a potential framework for developing important components of a pay-for-performance system for healthcare providers. If the costs for treating health conditions can be computed, then policymakers can in principle benchmark different providers' cost distributions and reward the most efficient. This article applies two of the most prominent commercial groupers and examines the properties of the cost distributions calculated for their constructed episodes. The analysis reveals that episode cost distributions exhibit substantial variation and skewness, suggesting the need for innovative risk adjustment methods prior to utilizing groupers for the purpose of physician profiling.

The management of first episode genital herpes in genitourinary medicine clinics: a national audit in 2006.

A national audit of the management of first episode genital herpes (GH) was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the United Kingdom. In total, 1620 data collection forms were completed (794 men and 826 women). Virus culture is the main detection method (1150, 71%), although polymerase chain reaction (PCR) use is increasing (442, 28%). PCR was significantly associated (P<0.0001) with fewer negative isolates (29/442, 6.6%) compared with virus culture (174/1150, 15%). Herpes simplex virus type 1 was isolated in 552 cases (46%). For 243 cases (15%), there was no evidence of counselling about GH. A total of 1355 (84%) were screened for other sexually transmitted infections. Serological testing for syphilis was undertaken in 72%. GU medicine clinics are managing first episode GH as broadly outlined in the guidelines. Areas identified for improvement are to increase counselling/written information/testing for syphilis towards 100%.

Improving sexual health services in the city: can the NHS learn from clients and the service industry.

OBJECTIVE: Genitourinary service providers are struggling to meet patient demand and have introduced changes in access structure to cope. In this study, we explored the perspectives of clients and providers upon the different models of access introduced and whether these maintained service quality using the SERQUAL model. METHODS: Primary data were collected in May 2005 at two genitourinary medicine clinics, two Accident and Emergency Departments and from members of a university 'gay' society all of which were located in London. Forty-four high-risk clients and 11 health service providers underwent semi-structured face-to-face interviews. RESULTS: Both the walk-in and appointment-based access systems were appreciated by clients. Clients said that the most important issue was that they were not turned away when they presented. Health-care providers had a variety of opinions about the two systems as they had different impacts on morale, training and service provision. CONCLUSIONS: Service quality can be maintained by using both walk-in and appointment-based systems. This is because our data, in line with Parasuraman's model of service quality, showed that 'access' is but one determinant of quality. Having different modes of access facilitates patient choice, which is paramount in a modern health-care system. However, to provide a good service it is important to maintain a motivated staff, who can be affected by their working environment.

The management of Chlamydia trachomatis in genitourinary medicine clinics: a national audit in 2004.

The first national audit of the management of Chlamydia trachomatis was undertaken by non-consultant career grade doctors working in genitourinary (GU) medicine clinics in the UK. During the audit period of January--March 2004, 1670 data collection forms were completed (from 830 men and 840 women with chlamydia). In all, 99% (1647) were treated appropriately; 76% (1261) were followed up, of which 12% (154) required re-treatment; 71% (1186) were managed appropriately within four weeks and 942 partners (0.56 per index case) were managed satisfactorily within four weeks of the initial partner notification interview. Partner notification outcomes were significantly more successful when the index patient was followed up (P<0.0001). Outcome standards were not associated with age, gender or sexuality, but were significantly associated with ethnicity (P<0.004). GU medicine clinics are delivering high-quality care and evidence-based national outcome standards are being met.