Innovative Urban ED Clinic Addresses Unmet Sexual Wellness Needs

Comprehensive Sexual Wellness Clinic in an Urban Academic Medical Center Emergency Department: A Novel Approach to Addressing Unmet Health Needs

Background

The closure of nearby city-run sexually transmitted infection STI clinics led to a critical gap in care for the underserved population living near our large urban academic medical center. Patients, who are often uninsured or underinsured, have been relying on the Emergency Department ED as their primary source for addressing sexual health concerns and managing STIs.

Objective

To tackle this unmet need, we innovated a Sexual Wellness Clinic SWC, designed to provide comprehensive sexual healthcare and primary care linkage services for individuals presenting with STI complnts at our ED.

Implementation

All patients identified as SWC-eligible undergo an initial Medical Screening Exam MSE by a triage physician prior to transport to the clinic. Exceptions include pregnant patients, those under 18 years of age, victims of sexual assault, and individuals requiring acute care beyond what the SWC can provide.

Upon arrival at the SWC, each patient receives:

• A complete medical history and physical examination

• Comprehensive STI testing including but not limited to gonorrhea, chlamydia, and syphilis

• Empiric treatment for positive test results as needed

• Same-day initiation of Pre-Exposure Prophylaxis PrEP if appropriate

• Assistance in arranging primary care follow-up at our institution or through affiliated Federally Qualified Health Centers FQHCs

Initial Outcomes

In the first 8 weeks following its launch, the SWC served 28 patients. Demographically, 35.6 identified as cis-female and 64.2 as cis-male. All female patients self-identified as women who have sex with men WWSM, while 89 of male patients defined themselves as men who exclusively engage in sex with women MSWWM. Age ranged from 18 to 55 years, with a mean age of 25.

Among the tested populations:

• 17.8 tested positive for gonorrhea

• 7.1 showed evidence of chlamydia

• Syphilis testing was negative across all cases

Innovatively, same-day PrEP initiation saw adoption in 28.5 of patients who were identified as being at risk. Of these:

• 62.5 n=5 were female

• 37.5 n=3 were male

The SWC successfully linked 79 of patients to primary care services following their visit.

The establishment and operationalization of the SWC within our ED demonstrate a feasible delivering specialized sexual health services in urgent care settings. This initiative highlights the importance of addressing STIs, particularly among populations that are often overlooked, including heterosexual men and women. Targeting these at-risk individuals is pivotal to local and national efforts med at eliminating HIV.

Implications

The operational success of this SWC suggests a novel approach to integrating sexual health services in under-resourced areas and within acute care environments. It underscores the significance of multi-disciplinary collaboration between emergency physicians, healthcare social workers, and primary care providers in addressing the complex needs of marginalized populations. Further research into refining workflow efficiencies, expanding access points, and optimizing patient engagement strategies could enhance its broader applicability.

Disclosures

All authors declare no conflicts of interest relevant to this publication.

This revised version retns the core information from the original while enhancing clarity, improving coherence, and streamlining language for a more polished presentation suitable for academic or professional publications. The use of inclusive terminology and clear categorization enhances accessibility for readers across various fields. The highlights both achievements and future directions for potential improvement, aligning with scholarly expectations for insightful analysis and discussion.

This article is reproduced from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6810973/

Please indicate when reprinting from: https://www.lp61.com/STD_hospital/Sexual_Wellness_Clinic_IN_ED.html