Abstract
Sirs: Following the introduction of a new Saturday service, our three-month evaluation 1 showed that more men, more patients with symptoms and more patients with sexually transmitted infections (STIs) attended on Saturday. We have now completed a 12-month service evaluation and this letter provides those additional data.
A retrospective case-notes review was undertaken for all patients attending Saturday clinics (January to December 2009). Gender, proportions with symptoms and proportions with STI codes were compared with 12-month clinic data (KC60 codes – Department of Health diagnostic codes for STIs and genitourinary medicine access monthly monitoring [GUMAMM] data).
Of the 755 new/rebook Saturday patients, 391 (52%) were men and 364 (48%) women. From 12-month KC60 data, a total of 12,764 new/rebook patients attended of which 5198 (41%) were men and 7566 (59%) women. More men attended the Saturday service (P < 0.00001) than during weekday services.
From Saturday GUMAMM data, 241 (32%) declared at the reception desk that they had symptoms. From 2009, GUMAMM data for all new/rebook patients, 3596 (28%) declared they had symptoms and 1358/5216 (26%) of all walk-in patients declared they had symptoms. From case-note review 428/755 (57%) Saturday patients had symptoms, whereas from 1000 consecutive notes from all clinics, 496/1000 (50%) had symptoms. Not only were Saturday patients more likely to declare symptoms (P = 0.03), but also they were more likely to have symptoms (P = 0.003).
Of the new/rebook Saturday patients 309 (41%) had one or more STI codes compared with 12-month KC60 data when 4440/12,764 (35%) STI codes were recorded. Saturday patients were more likely to have an STI (P = 0.0006). Table 1 shows the breakdown of KC60 codes. From the whole sample, 188/391 men had one or more STI codes (48.1%, 95% CI 43.1–53.0%) compared with 121/364 women (33.2%, 95% confidence interval (CI) 28.4–38.1%) (P = 0.00003). When all non-D3 codes (STI codes plus other significant genital condition codes) were considered, there was no association with gender (P = 0.8).
KC60 codes (sexually transmitted infection codes and other codes) for the Saturday patients and according to gender
CI = confidence interval; STI = sexually transmitted disease
*Some patients had more than one KC60 code
Our requirement to open a weekend service was driven by a local Strategic Health Authority target. When the Saturday service was first commenced, it was intended that it should be for new problems only, i.e. an urgent rather than a routine service. Saturday follow-up appointments were discouraged unless the patient really could not reattend at some other time during the week and there was no cryo-therapy available on Saturdays. Staffing included one receptionist, two doctors or one doctor plus one senior nurse, two health-care assistants and one health adviser. The estimated total cost of the Saturday service meant that we needed to see a minimum of 13 new patients per clinic in order to break even. A total of 805 patients (755 new/rebook and 50 follow-up) attended 44 clinics in the year, making an average of 18 patients (17 new/rebook and one follow-up) per clinic. Looking at postcode data for the 755 new/rebook patients, 558 (74%) came from Plymouth city postcodes, 146 (19%) from surrounding rural areas, 27 (4%) from other areas/cities and for 24 (3%) postcodes were not known.
We asked consecutive patients attending on Saturdays to complete a brief multiple choice questionnaire to ask why they had chosen to attend at that time (choices: earliest appointment/other commitments/other free text reason). At the same time we also asked patients attending one of our three evening clinics (Monday, Wednesday and Thursday) to complete the same questionnaire. Questionnaires were completed by 300 (150 men [M]: 150 women [F]) Saturday patients and 300 (137M: 163F) evening patients. Results for Saturday patients showed 152 (51%) wanted the earliest available appointment (i.e. shortening the weekend interval) compared with 130 (43%) evening patients wanting the earliest appointment. This did not reach significance (P = 0.07). More evening patients chose the evening because of other commitments – 170 (57%) compared with 148 (49%) on Saturday. Unfortunately, we did not specifically ask about hours of employment so we cannot provide a breakdown of what ‘other commitments’ actually means such as conflict with hours of employment, difficulty with childcare issues or mere inconvenience etc. These are data that we must collect in the future and then compare the results of the evening clinics with Saturdays. It may be that the results will be similar or it may help to define further whether the weekend gap is an important issue for patients.
We could find no other data on Saturday services. 1 From our data one year on, we conclude that our Saturday service is affordable, sustainable and in our patients' interests. Other clinics may wish to look at the needs of their local population and design services appropriate to their own area. It would be interesting to hear from other clinics who may have tried to introduce a Saturday service, but found it unsustainable.