Improving access to sexual health services

Steph TewCase Study, Slider

woman using smartphone in bed
woman using smartphone in bed
Overview

The COVID-19 restrictions established in March meant that patients were no longer able to use walk-in clinics to seek treatment or advice for sexual health issues in Plymouth.

Increased and innovative use of the Patients Know Best (PKB) platform enabled the Sexual Health in Plymouth (SHiP) team to remotely and securely treat over 900 new patients between April – August 2020.

60% of patients in the SHiP satisfaction survey stated that they are happy to share images securely with their clinical team using the PKB digital platform.

An average of 150 messages are exchanged between patients and professionals each week.

375 SHiP patients logged into their PKB account more than once during July 2020 to view their record and interact with the clinical team. 

An overwhelming 99% of patients (including those using PKB) who had a telephone consultation, reported being satisfied with the consultation and felt comfortable with the clinician using this approach for their ongoing consultations.  

Access to care in a digital format has proved to be beneficial for the patient experience; there is no longer the need to take time off work, arrange childcare or incur travel costs to be able to engage with clinicians. This also reduces the local carbon footprint.

The SHiP Team (taken February 2019 pre social-distancing rules)
Background

Sexual Health in Plymouth (SHiP) is a partnership of experienced organisations working together to deliver integrated sexual health, HIV, contraception and abortion services for Plymouth, East Cornwall and South West Devon. The partnership includes University Hospitals Plymouth NHS TrustPlymouth City Council, The Zone and the Eddystone Trust. SHiP services are accessed by a population of approximately 500,000 people in Plymouth and the surrounding areas.

COVID-19 and the need to treat sexual health patients remotely

As the coronavirus (COVID-19) struck the UK in March 2020, the SHiP team were forced to pause all walk-in services with NHS restrictions in place to limit the spread of the virus. The team quickly looked at different ways to support patients remotely whilst overcoming a number of challenges:

  • Rapidly adapt workflows to ensure patients could continue to be diagnosed safely and continue to engage with clinicians. 
  • Immediately replace face-to-face appointments. 
  • Securely share data between the patient and the clinician, in particular for visual and often intimate images. 
  • Ensure patients did not delay coming forward for help during the pandemic. The stigma of sexual health diseases can often delay a patient from seeking help and can quickly escalate into a public health issue. 
  • Provide staff with the administrative and communication tools to continue providing a safe and secure service to the population they cover.
Increased use of Patients Know Best

The SHiP team has been using the PKB platform since 2014, supporting patients with HIV to manage their care by sharing access to medical data including test results to help respond to changes in their condition. With the software already in place, the team decided to scale their usage from March to provide additional digital-first services for patients seeking treatment and advice from their Sexual Health and Abortion Service teams.

Dr Zoe Warwick, Consultant in Sexual Health and HIV at SHiP, said:

“Our department’s decision to increase its use of PKB has had a significant upside for the patient experience. People seeking treatment can use PKB to engage with our team through their computers, tablets and smartphones, which means that they can get the treatment or advice they need without having to take time off work, or incur costs such as travel and parking. 

The SHiP team adapted their workflow so that the reception staff explained the use of PKB to the patient during their initial telephone call, collected their email, and then sent them an invitation via email to register for PKB. Once registered, the clinicians were able to communicate with,  and remotely manage patients securely using  PKB in the following ways:

Sexual health patients

The patient is messaged in PKB by their clinician, explaining how they can securely send images within PKB. This process conforms with the NHS best practice guidance relating to intimate remote clinical assessments updated in July 2020.

The clinician receives a secure message and any related images for the purposes of diagnosis. The clinician can then contact the patient through PKB messaging or via telephone to discuss the next steps.

The patient is also able to view relevant signposting health information shared by their clinician in the library section.

Patients considering an abortion

The Pregnancy Advisory Clinic (PAC) team created a Nurse PAC Pre-Assessment form that the patient fills out within PKB ahead of their scheduled remote appointment. This allows the nurse to review the information prior to their virtual meeting or telephone call discussion with the patient. The assessment covers the following areas:

  • COVID-19 symptoms and contact
  • Medical history
  • Birthing history
  • Social history
  • Possible contraception options.
Security and patient confidentiality

The security of patient data is paramount for sexual health services. PKB enables a secure way of communicating between patients and clinicians to share intimate images so that nothing is saved and consequently lost or inappropriately accessed on individuals phones, laptops or computers. All data is sent, received and viewed securely within PKB.

By getting set up as a ‘team’ within PKB allows clinicians to be confident and ensure that patient communication is not delayed by one clinician. PKB shows the data and allows responses from the entire team, including the patient.

For complete patient confidentiality, sexual health clinics hold health records separate from the rest of a patient’s hospital and GP data. This allows the patient to only share sexual health data with healthcare professionals they wish to inform. PKB enables data points to be attached under four different digital privacy labels – General Health, Sexual Health, Social Care and Mental Health. All data sent by SHiP within PKB is categorised under the ‘Sexual Health’ privacy label. This means that only the clinicians listed under the sexual health category can access the relevant information, allowing the SHiP department to replicate the face-to-face confidentiality processes within a virtual setting.

Positive outcomes for patient experience

During the first 4 and a half months of the COVID-19 lockdown (April – August 2020), the SHiP team registered and treated 900 patients through PKB. This number continues to grow by around 40 to 50 patients a week. 

An average of 150 messages are exchanged between patients and professionals each week and 375 SHiP patients logged into their PKB account more than once during July 2020 to look at their record and interact with their clinical team. 
The administrative and nursing teams have committed to using PKB to reform their workflow, and the department now has 37 PKB professional users who can engage with patients about their healthcare through the platform.

Additional patients benefits have included:

  • More convenience for patients, who no longer have to take time off work or arrange child care.
  • No travel costs for patients.
  • 60% of patients in the SHiP satisfaction survey stated that they are happy to send photos securely via PKB.
  • The ability to share their sexual health data discreetly and securely with the clinicians and healthcare professionals they choose.

With patient and staff satisfaction high, the team will continue to build on their use of the platform to support patients to access sexual health services without stigma. Dr Warwick concluded:

“We have had really positive feedback from our patients, and a significant majority of them are very happy to securely message and send images to their clinicians. Promoting this service will enable more people to avoid having to attend the clinic and ensure that they are receiving the same high-quality level of care.”