Gonorrhea, Chlamydia
Conditions
Keywords
ACASI, Gonorrhea, Chlamydia, Emergency Department, Youth, Adolescents, Computer, Questionnaire
Brief summary
The purpose of this study is to determine if an Audio-enhanced Computer-Assisted Self-Interview (ACASI) will lead to increase testing for sexually transmitted infections in youth visiting a pediatric ED
Detailed description
The purpose of this study is to see if computer based health surveys for teenagers and young adults in the emergency department can improve the care we give, even for things that are not related to why they came to the emergency department. Topics that are important in this age range include depression, violence, sexual behavior, physical activity and nutrition, though we are not asking about all of these. WHAT WILL HAPPEN DURING THIS STUDY? We wish to respect the privacy of everyone takes this survey. In order to do this, we are asking all relatives including your parents or guardians to respect several things so that you may participate: * We cannot tell family or friends the exact questions on the survey * You must be given complete privacy to answer the questions * The answers will only be shown to the healthcare team taking care of them today and the people running the study - family members will not be shown the answers * Family and friends will not pressure you to discuss the survey or their answers after you are done * You will be given privacy to discuss their answers with the healthcare team If you do not feel your friends and family can respect these requests, then you cannot take the survey and cannot enroll in the study. If you agree to these requests, we will use a private area and allow you to use a computer to do the following: * Explain in more detail what types of questions we will ask and why they are important * Tell you how we will use your answers to improve their health care * Give you a chance to answer any questions you have about the study * Answer a series of questions about yourself and your health You are allowed to skip any questions you do not want to answer and can stop at any time. After you have completed the survey, a summary of your answers will become part of your medical record from today and be shown to the doctors and nurses taking care of you today. Most participants will be asked to review their answers in private with the doctors and nurses taking care of them. If you do, your family and friends will be asked to step out of the room while you review the answers with the doctors and nurses. Some participants may have additional testing or services done as part of their visit today based on their answers
Interventions
BEHAVIORALACASI
Youth who participated in this study completed the ACASI -- they provided details about their sexual history, and the software program used their responses to create a recommendation for chlamydia/gonorrhea testing. The information obtained through the ACASI was integrated into the emergency department (ED) electronic medical record. ED physicians and nurses were able to review the information and order chlamydia/gonorrhea testing if needed.
Sponsors
St. Louis Children's Hospital
Washington University School of Medicine
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SCREENING
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
15 Years to 21 Years
Healthy volunteers
No
Inclusion criteria
* Patient in the St. Louis Children's Hospital Emergency Department * 15-21 years old
Exclusion criteria
* Evaluation of abuse or sexual assault * Activation of the trauma system, * Level 1 or 2 triage scores (highest severity) * Disabilities preventing independent computer use * Psychiatric chief complaints * Inability to speak English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Gonorrhea and Chlamydia Testing in the Pediatric ED | 27 months | The primary outcome was change in the proportion of adolescent patients receiving chlamydia and gonorrhea testing rates during their ED visit over 4 time periods. Period 1) 2010 testing as a historical control Period 2) Jan 2011, began providing staff education about the risks of gonorrhea/chlamydia and need for increased testing Period 3) Education continues, but enrolled patients in the ACASI from April 18, 2011 - Dec 20, 2011. Period 4) ACASI enrollment completed, education continued through March 2012 We specifically analyzed gonorrhea/chlamydia testing among ED patients that would have been eligible to take the ACASI, had it been continuously available throughout these time periods. We did this to isolate the effects on testing by the ACASI vs. education alone. |
Countries
United States
Participant flow
Recruitment details
We monitored overall testing in the ED from Jan 2010 - March 2012, but only actively enrolled patients from April 18, 2011 - Dec 20, 2011. All ACASI participants were patients in the St. Louis Children's Hospital ER.
Pre-assignment details
There was an education lead in before introducing the ACASI, to see if education alone would increase the amount of patients receiving gonorrhea/chlamydia testing. The education started in Jan, 2011 and continued the remainder of the study period.
Participants by arm
| Arm | Count |
|---|---|
| ACASI The group of patients that agreed to participate in the study and answer questions on our Audio-enhanced Computer-Assisted Self-Interview (ACASI)
ACASI : Youth who participated in this study completed the ACASI -- they provided details about their sexual history, and the software program used their responses to create a recommendation for chlamydia/gonorrhea testing. The information obtained through the ACASI was integrated into the emergency department (ED) electronic medical record. ED physicians and nurses were able to review the information and order chlamydia/gonorrhea testing if needed.
We compared testing over 4 time periods: 2010 (baseline), Jan - April 17, 2011 (education only), April 18-2011 - Dec 20, 2011 (education + enrollment in ACASI), and Dec 21, 2011 - March 31, 2012 (education only, ACASI enrollment stopped. | 8,421 |
| Total | 8,421 |
Baseline characteristics
| Characteristic | ACASI |
|---|---|
| Age, Categorical <=18 years | 7042 Participants |
| Age, Categorical >=65 years | 0 Participants |
| Age, Categorical Between 18 and 65 years | 1379 Participants |
| Age Continuous | 17.0 years STANDARD_DEVIATION 1.3 |
| Region of Enrollment United States | 8421 participants |
| Sex: Female, Male Female | 4643 Participants |
| Sex: Female, Male Male | 3778 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 0 / 801 |
| serious Total, serious adverse events | 0 / 801 |
Outcome results
Primary
Gonorrhea and Chlamydia Testing in the Pediatric ED
The primary outcome was change in the proportion of adolescent patients receiving chlamydia and gonorrhea testing rates during their ED visit over 4 time periods. Period 1) 2010 testing as a historical control Period 2) Jan 2011, began providing staff education about the risks of gonorrhea/chlamydia and need for increased testing Period 3) Education continues, but enrolled patients in the ACASI from April 18, 2011 - Dec 20, 2011. Period 4) ACASI enrollment completed, education continued through March 2012 We specifically analyzed gonorrhea/chlamydia testing among ED patients that would have been eligible to take the ACASI, had it been continuously available throughout these time periods. We did this to isolate the effects on testing by the ACASI vs. education alone.
Time frame: 27 months
Population: We analyzed every patient in this time period that met our ACASI inclusion/exclusion criteria
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Historical Control | Gonorrhea and Chlamydia Testing in the Pediatric ED | 9.7 percentage of participants |
| Initial Education Period | Gonorrhea and Chlamydia Testing in the Pediatric ED | 9.3 percentage of participants |
| ACASI + Education | Gonorrhea and Chlamydia Testing in the Pediatric ED | 17.8 percentage of participants |
| Final Education Period | Gonorrhea and Chlamydia Testing in the Pediatric ED | 12.4 percentage of participants |
Comparison: We compared testing in the 4 time frames described, including the time frame in which we enrolled patients in the ACASI.p-value: <0.001Chi-squared