Assessing the impacts of integrated decision support software on sexual orientation recording, comprehensive sexual health testing, and detection of infections among gay and bisexual men attending general practice: Observational study

Denton Callander*, Christopher Bourne, Handan Wand, Mark Stoové, Jane S. Hocking, John De Wit, John M. Kaldor, Basil Donovan, Catherine Pell, Robert Finlayson, David Baker, Bradley Forssman, B. K. Tee, Bill Kefalas, Tim Duck, Rebecca Guy

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Gay and bisexual men are disproportionately affected by HIV and other sexually transmissible infections (STIs), yet opportunities for sexual health testing of this population are often missed or incomplete in general practice settings. Strategies are needed for improving the uptake and completeness of sexual health testing in this setting. Objectives: The goal of the research was to evaluate the impact of an intervention centered around integrated decision support software and routine data feedback on the collection of sexual orientation data and sexual health testing among gay and bisexual men attending general practice. Methods: A study using before/after and intervention/comparison methods was undertaken to assess the intervention’s impact in 7 purposively sampled Australian general practice clinics located near the urban centers of Sydney and Melbourne. The software was introduced at staggered points between April and August 2012; it used patient records to prompt clinicians to record sexual orientation and accessed pathology testing history to generate prompts when sexual health testing was overdue or incomplete. The software also had a function for querying patient management system databases in order to generate de-identified data extracts, which were used to report regularly to participating clinicians. We calculated summary rate ratios (SRRs) based on quarterly trends and used Poisson regression analyses to assess differences between the 12-month preintervention and 24-month intervention periods as well as between the intervention sites and 4 similar comparison sites that did not receive the intervention. Results: Among 32,276 male patients attending intervention clinics, sexual orientation recording increased 19% (from 3213/6909 [46.50%] to 5136/9110 [56.38%]) during the intervention period (SRR 1.10, 95% CI 1.04-1.11, P<.001) while comprehensive sexual health testing increased by 89% (305/1159 [26.32%] to 690/1413 [48.83%]; SRR 1.38, 95% CI 1.28-1.46, P<.001). Comprehensive testing increased slightly among the 7290 gay and bisexual men attending comparison sites, but the increase was comparatively greater in clinics that received the intervention (SRR 1.12, 95% CI 1.10-1.14, P<.001). In clinics that received the intervention, there was also an increase in detection of chlamydia and gonorrhea that was not observed in the comparison sites. Conclusions: Integrated decision support software and data feedback were associated with modest increases in sexual orientation recording, comprehensive testing among gay and bisexual men, and the detection of STIs. Tests for and detection of chlamydia and gonorrhea were the most dramatically impacted. Decision support software can be used to enhance the delivery of sexual health care in general practice.

Original languageEnglish
Article numbere10808
JournalJournal of Medical Internet Research
Volume20
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Funding

Funding for this project was provided by the New South Wales Ministry of Health and University of New South Wales (UNSW) Sydney. The authors acknowledge the following people and organizations for their support and guidance: Anna Roberts (Australasian Society for HIV, Viral Hepatitis, and Sexual Health Medicine); Craig Cooper (Positive Life NSW), Geoff Honnor (AIDS Council of New South Wales); Sonny Williams (Positive Life NSW); Marianne Gale (NSW Ministry of Health); Vijay Ramanathan (Royal Australian College of General Practitioners); and Liza Doyle, Larissa Lewis, and Fraser Drummond (Kirby Institute, UNSW Australia). The authors also acknowledge the developers and managers of the PrimaryCare Sidebar sexual health module, in particular Christine Chidgey, Paul Matthews, and Monica Schlesinger (PEN Computer Systems). Data from pathology laboratories were extracted with the help of the following people: Lisa Crawford (Douglas Hanly Moir), Stella Pendle and Adrian Yap (Australian Clinical Labs), Lisa Katon and Joymarie Armstrong (SydPath Central Laboratory), Rob Warren (Victorian Infectious Diseases Reference Laboratory), and Gareth Halbert (Laverty Pathology). And finally, the authors acknowledge the tremendous contribution of practice managers and nursing staff at participating clinics, namely Shakira Watts, Esme Sinnott, Jo Toomey, Marie Stoal, Marion Solomon, Elisha Smith, Claire Johnson, Erin McDonald, Alastair Colgrave, Lucy Kalangi, Cheryl Walker, Danielle Collins, and Simon Powell. For the provision of additional data, the authors acknowledge additional ACCESS investigators who are not authors on this paper, Carol El-Hayek and Margaret Hellard.

Keywords

  • General practice
  • Men who have sex with men
  • Sexual health
  • Software
  • STI

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