Computerized self-interviews improve Chlamydia and gonorrhea testing among youth in the emergency department

Area of Science:

• Public Health
• Infectious Diseases
• Health Informatics

Background:

• National guidelines advocate for annual screening of sexually active youth for Chlamydia trachomatis and Neisseria gonorrhoeae.
• Untreated infections pose significant risks to women's health, necessitating improved testing strategies.
• Emergency departments (EDs) are potential settings for identifying and testing at-risk youth.

Purpose of the Study:

• To evaluate the effectiveness of an electronic method in identifying at-risk youth for sexually transmitted infection (STI) testing during ED visits.
• To determine if an audio-enhanced computer-assisted self-interview (ACASI) can increase STI testing rates in a young patient population.

Main Methods:

• Developed an ACASI system with an embedded decision tree to recommend STI testing based on sexual history.
• ED healthcare providers were prompted via the electronic medical record to review ACASI results and offer testing.
• Eligible participants were 15- to 21-year-olds visiting a children's hospital ED, irrespective of their presenting complaint.

Main Results:

• STI testing rates among eligible youth increased from 9.3% pre-ACASI to 17.8% during ACASI implementation, and decreased to 12.4% post-withdrawal (P<.001).
• Of 800 enrolled participants, 52.4% received an STI testing recommendation, and 52.7% of those were tested in the ED.
• Among tested patients, 18.1% were positive for chlamydia or gonorrhea; 55% of these had unrelated chief complaints. 89% found the ACASI easy to use.

Conclusions:

• The ACASI system significantly enhanced STI testing rates among youth in the ED setting.
• The ACASI tool demonstrated high user acceptance among young patients.
• This electronic approach shows promise for improving STI screening in emergency departments.