26 October 2021
A rapid sexual health service designed to improve access and delivery of care is welcomed by staff and patients, National Institute for Health Research (NIHR) funded researchers at the University of Bristol have found.
Demand for HIV and sexually transmitted infection (STI) testing is on the rise, but local authority budgets are shrinking. Patients typically waited over a week for chlamydia and gonorrhoea test results, and then had to return to the clinic for treatment.
The results of a joint NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and NIHR Applied Research Collaboration (ARC) West funded interview-based study have been published in BMJ Open. The paper examines the experiences of implementing a first-of-its-kind rapid STI testing, diagnosis and treatment service delivered in Unity Sexual Health which provides sexual health services for Bristol, North Somerset and South Gloucestershire.
The service involves patients dropping off their samples which are then checked with new rapid testing equipment, so that results, treatment and advice can be given within hours. As most STIs do not cause any symptoms, early detection and treatment can help stop infections spreading and prevent serious disease developing.
The research team interviewed 26 patients who used the service in Bristol, and 21 staff working in the service, to find out their experiences and views. They also spent 40 hours observing the day-to-day running of the new service.
Patients valued the faster results, infection-specific treatment and avoiding unnecessary treatment. The rapid results meant that patients could be treated based on their test results, rather than being prescribed antibiotics ‘just in case’ of an infection. Staff welcomed being able to provide treatment based on results and both staff and patients valued avoiding unnecessary antibiotic prescribing. Most patients accepted the need to attend the clinic to drop samples off and return for a follow-up appointment.
The rapid testing service was successfully implemented despite funding and staff shortages. offsetting up the new service required co-ordinated changes in practice across multiple teams.
Several small ‘pilots’ of process changes were necessary to find workable options. This responsive operating mode created challenges for delivering comprehensive training and communication in advance to all staff. Engaging all staff and changing ingrained behaviours caused some initial difficulties. Inevitable teething glitches were resolved and, overall, staff worked together to adjust and improve the new service, and morale was buoyed through observing positive impacts on patient care.
Interviews and observations revealed benefits of the new rapid results service including:
- reduced patient anxiety due to faster results and treatment
- being able to see more patients
- boosting staff job satisfaction as many were excited about doing something new to improve service access
The evaluation benefitted the staff, as researchers provided ongoing rapid feedback which prompted suggestions for service improvements and provided a space for reflection. Early evaluation of pilots of process changes played an important role in the success of the service, by rapidly feeding back issues for adjustment.
Suggestions for future service changes
These findings also provide valuable information for policymakers and healthcare professionals across the UK who may be interested in setting up similar rapid services:
- Consult with patients when redesigning services
- Involve all staff in planning, design and implementation
- Protect staff time for meetings and actions
- Document new pathways and processes early and comprehensively disseminate to staff
- Conduct pilots with a small group of staff and patients
- Use varied methods of communication about service changes that are sensitive and supportive
- Consider the impact on different staff roles and ensure staffing capacity to cover changes
Dr Ava Lorenc, Senior Research Fellow from University of Bristol Medical School and NIHR ARC West and a lead author of the study, said: “This was an exciting study to work on, as the intervention is so new. It was great to hear first-hand the potential benefits of rapid testing and the sense of pride among clinic staff in developing this new service. Although the process was challenging for the clinic staff, it was great to see the team work together to overcome barriers and successfully implement the service”
Dr Paddy Horner, Consultant in Sexual Health and HIV from Unity Sexual Health and NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol, who co-led the study, said: “The implementation of the new rapid sexual health service was a massive undertaking by our clinic. The support and feedback from the NIHR ARC West qualitative research team was invaluable in ensuring its successful implementation and was highly valued by staff.”
Jeremy Horwood, Professor of Social Sciences and Health from the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol and NIHR ARC West, who co-led the study, said: “The evaluation played a vital role in the success of implementing the new service, by rapidly feeding back issues to help refine the design of the service and feeding back the positive impacts on patient care, which help boosted team morale. This demonstrates the important role rapid qualitative methods can provide in helping to improve service changes as implementation happens.”
Paper: What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing diagnosis and treatment service? by Ava Lorenc et al. Published in BMJ Open. October 2021.
About the NIHR Health Protection Research Unit [HPRU] in Behavioural Science and Evaluation at the University of Bristol
The NIHR HPRU in Behavioural Science and Evaluation at University of Bristol is one of 14 HPRUs across England, part of a £58.7 million investment by the NIHR to protect the health of the nation.
The NIHR HPRU in Behavioural Science and Evaluation is a partnership between the UK Health Security Agency (UKHSA) and University of Bristol, in collaboration with MRC Biostatistics Research Unit at the University of Cambridge and University of the West of England.
Each NIHR HPRU undertakes high quality research that is used by UKHSA to keep the public safe from current and emerging public health threats.
About the NIHR
The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
- Funding high quality, timely research that benefits the NHS, public health and social care;
- Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
- Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
- Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
- Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
- Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.
NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.
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