TY  - JOUR
AU  - McCormack, Heather
AU  - Wand, Handan
AU  - Newman, Christy E
AU  - Bourne, Christopher
AU  - Kennedy, Catherine
AU  - Guy, Rebecca
PY  - 2023
DA  - 2023/11/30
TI  - Exploring Whether the Electronic Optimization of Routine Health Assessments Can Increase Testing for Sexually Transmitted Infections and Provider Acceptability at an Aboriginal Community Controlled Health Service: Mixed Methods Evaluation
JO  - JMIR Med Inform
SP  - e51387
VL  - 11
KW  - sexual health
KW  - sexually transmitted infection
KW  - STI
KW  - primary care
KW  - Indigenous health
KW  - electronic medical record
KW  - EMR
KW  - medical records
KW  - electronic health record
KW  - EHR
KW  - health record
KW  - health records
KW  - Indigenous
KW  - Native
KW  - Aboriginal
KW  - sexual transmission
KW  - sexually transmitted
KW  - time series
KW  - testing
KW  - uptake
KW  - acceptance
KW  - acceptability
KW  - adoption
KW  - syphilis
KW  - sexually transmitted disease
KW  - STD
KW  - systems change
KW  - health assessment
KW  - health assessments
KW  - prompt
KW  - prompts
KW  - implementation
KW  - youth
KW  - young people
KW  - adolescent
KW  - adolescents
AB  - Background: In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting. Objective: We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff. Methods: We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory. Results: Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse- and Aboriginal health practitioner–led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice. Conclusions: This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability. 
SN  - 2291-9694
UR  - https://medinform.jmir.org/2023/1/e51387
UR  - https://doi.org/10.2196/51387
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38032729
DO  - 10.2196/51387
ID  - info:doi/10.2196/51387
ER  -