Computer assisted self interviewing in a sexual health clinic as part of routine clinical care; impact on service and patient and clinician views

BACKGROUND: Computer assisted self interviewing (CASI) has been used at the Melbourne Sexual Health Centre (MSHC) since 2008 for obtaining sexual history and identifying patients' risk factors for sexually transmitted infections (STIs). We aimed to evaluate the impact of CASI operating at MSHC. METHODOLOGY/PRINCIPAL FINDINGS: The proportion of patients who decline to answer questions using CASI was determined. We then compared consultation times and STI-testing rates during comparable CASI and non-CASI operating periods. Patients and staff completed anonymous questionnaires about their experience with CASI. 14,190 patients completed CASI during the audit period. Men were more likely than women to decline questions about the number of partners they had of the opposite sex (4.4% v 3.6%, p = 0.05) and same sex (8.9% v 0%, p<0.001). One third (34%) of HIV-positive men declined the number of partners they had and 11–17% declined questions about condom use. Women were more likely than men to decline to answer questions about condom use (2.9% v 2.3%, p = 0.05). There was no difference in the mean consultation times during CASI and non-CASI operating periods (p≥0.17). Only the proportion of women tested for chlamydia differed between the CASI and non-CASI period (84% v 88% respectively, p<0.01). 267 patients completed the survey about CASI. Most (72% men and 69% women) were comfortable using the computer and reported that all their answers were accurate (76% men and 71% women). Half preferred CASI but 18% would have preferred a clinician to have asked the questions. 39 clinicians completed the staff survey. Clinicians felt that for some STI risk factors (range 11%–44%), face-to-face questioning was more accurate than CASI. Only 5% were unsatisfied with CASI. CONCLUSIONS: We have demonstrated that CASI is acceptable to both patients and clinicians in a sexual health setting and does not adversely affect various measures of clinical output

Mean consultation times of doctors and nurses seeing patients who have appointments or have been triaged in to the clinic as ‘complicated’ or ‘uncomplicated’ patients in CASI (2009) and non-CASI (2008 and 2010) periods.

a<p>Linear regression analysis for difference in consult time between CASI and non-CASI periods adjusting for potential intra cluster correlation from individual clinicians. n  =  total number of consults. Data was for 13 nurses and 17 doctors who saw patients in all of the three time periods.</p

Patient questionnaire separated for males and females.

a<p>Chi square test for differences in responses between genders; N  =  number of respondents of each sex for each question; n  =  number of patients who chose the option. One patient was excluded because they did not complete their gender.</p

Examples of comments made by clinicians about CASI operating at MSHC.

<p>CASI  =  computer assisted self interviewing, MSM  =  men who have sex with men.</p