Perceived level of expertise is a key factor influencing patients’ decision to attend GUM clinics rather than general practice for STI testing, a qualitative study has found. Waiting arrangements and method of receiving results were also important factors in selecting a service.

Ten focus groups were conducted in Brighton between August and October 2009 involving 65 patients aged 16 or over who had used STI testing services within the past 24 months.

Participants were allocated to eight of the groups according to age, sexuality and gender; a ninth group consisted of overseas students to reflect the demographic diversity of the area; the tenth group consisted of HIV-positive individuals of any age and gender. The focus groups were facilitated by two of the authors.

Patients’ preferences did not appear to be correlated with gender and sexual orientation.

For the majority the perceived expertise and specialism was the key reason for choosing a GUM clinic rather than a GP. However, every group thought GUM clinics were overcrowded which raised concerns about anonymity and discouraged attendance.

Testing for STIs in general practice was preferable for those with limited experience of STI testing and those who had a good relationship with their GP. The advantage of a generic waiting room was also highlighted. Younger patients preferred to visit their GP as this was more familiar but felt the tests offered could be limited.

Older patients, overseas students and those with HIV preferred GUM clinics. Some were reluctant to attend general practice because of the lack of time in a typical appointment.

Access to a full range of STI tests was important. Most participants assumed that a full range of STI tests was available at general practices offering sexual health services as well as at GUM clinics. A few suggested only GUM clinics provided the full range of tests.

Waiting in any form was unpopular but some indicated a preference for waiting in a drop-in centre to be seen on the day even if the wait was several hours whereas others viewed this negatively and even walked out of the clinic.

The most common preference for getting results was a phone call to a mobile or text message for a negative result. The no news is good news policy was consistently disliked because of the uncertainty.

The authors noted patients did not have a strong preference for using any particular venue and suggested commissioners and providers should make services outside GUM more acceptable to patients — especially to address the perceived lack of expertise and range of STI tests.

It was a pleasant surprise to hear that some people preferred to use general practice for STI testing especially younger patients and that the generic nature of general practice waiting areas helped to ease feelings of stigma and embarrassment.

The findings also demonstrated that holistic care involving sexual health in general practice is possible especially where there is a good doctor-patient relationship. However, for general practice to contribute effectively to sexual healthcare, we need to be confident and competent in offering

a range of STI tests that is not inferior to GUM clinics — especially in the case of asymptomatic screening. Time to consider our PUNs and DENs!

Dr Richard Ma

• Llewellyn C, Pollard A, Miners A et al. Understanding patient choices for attending sexually transmitted infection testing services: a qualitative study. Sex Transm Infect 2012;88:504-509