ISQUA17-2156CONTEMPORARY TECHNOLOGY FOR PATIENT-CENTRED INNOVATION – A MIXED METHOD EVALUATION IN SEXUAL HEALTH

Abstract

Objectives: SH24 (www.SH24.org.uk) is an award winning community interest company delivering state of the art, online diagnosis and treatment of sexually transmitted infections. It offers personcentered care to promote shared decisions through technologyenabled services. Developed using agile design and extensive user consultation it offers online information and ordering with tests and treatments by post. Users access the service via the website, telephone or text message with a 'mix and match' approach to service modality. The service links closely to local sexual health clinics. Initially this was through referral of complex cases from online to clinics and later through signosting of simple cases from clinics to SH:24. We measured the impact of this innovation on user behaviour and service activity across the whole sexual health economy within two London Boroughs with the highest rates of sexual health need in the UK. Methods: A mixed methods evaluation of the impact of online sexual health services on the whole sexual health economy including a 2000 participant randomised controlled trial of impact on access and descriptive analysis of routinely collected data from all sexual health providers to document shifts in activity across the whole sexual health economy. Results: The introduction of online services to the sexual health economy changes patterns of use across the whole system. Online provision doubles uptake of testing for sexually transmitted infections (RR 1.87, 95% confidence interval 1.63 to 2.15, p < 0.0001) attracting those who have never previously used services (27% of online users). Early adopters are more likely to be of white ethnicity (71% online compared to 39% in clinic) and men who have sex with men (17% online compared to 13% in clinics) but online services increase access by the same proportion for all groups. 76% of users complete the online test process. In a system that has insufficient capacity to meet demand, online services increase total testing and infections diagnosed, adding to baseline system activity. Triage at clinics and re‐direction online is required to shift activity to the online service. While the experience of those who make this transition remains positive this risks reducing access to testing among the 25% redirected online who fail to complete the testing process. Conclusion: Online sexual health services increase access, attract new users and improve user experience. Online services rarely operate in isolation because of the limits to clinical services without face‐to‐face interaction. Their evaluation benefits from a whole systems approach that acknowledges their interaction with the facilities that they refer to or accept referrals from. In sexual health economies that re‐direct users out of clinics towards online options total capacity is increased but choice is reduced. Further work is required to understand the interfaces between these modalities of care. Triage that predicts ability to switch service modality with targeted support could reduce barriers to access for those who do not transition effectively.