JMIR Publications

ABSTRACT

Background:

A service evaluation captured the use and explored the safety of three remote communication strategies within an online service offering remote prescriptions of antibiotics, delivered by post, for uncomplicated genital Chlamydia trachomatis. User acceptability and time-from-diagnosis to-treatment were also obtained.

Objective:

A service evaluation captured the use and explored the safety of three remote communication strategies within an online service offering remote prescriptions of antibiotics, delivered by post, for uncomplicated genital Chlamydia trachomatis. User acceptability of service and time-from-diagnosis to-treatment were also obtained.

Methods:

Three iterations of the service were compared, where medical history was collected by text message, telephone and online form before prescription. We contacted users after their prescription and completed the medical history a second time by telephone, asking when they took medication and how they felt about the service. The primary safety measure was agreement in information supplied at the two assessments on key elements of safe prescribing; allergies, medications or contraindicating clinical conditions or symptoms. Agreement in information between clinical and evaluation assessment was summarised as a binary variable. Factors associated with assessment agreement variable were explored using univariate, and multivariate, analysis. The secondary evaluation measures were; recall of/adherence to instructions for taking medication; time-from-diagnosis-to-treatment; acceptability of remote service. A Kruskal-Wallis H test determined the relationship between median time-to-treatment and method of clinical assessment.

Results:

All online service users, resident in the London Boroughs of Lambeth and Southwark with a positive chlamydia diagnosis, who were eligible for and chose postal treatment between 15/02/17 and 24/10/17, were invited to participate in this service evaluation. Of 321 eligible users, 199 (62.0 %) participated. 55 (27.6%) completed the clinical assessment by text, 81 (40.7%) by telephone and 63 (31.7%) using an online form. Those who were assessed for prescription via text were less likely to have an agreement in safe prescribing information than those assessed by telephone (AOR 0.22 (CI 95% 0.08 - 0.61, P =0.004)). We found no statistically significant difference in odds of agreement between online form and telephone assessment (AOR 0.50 (CI 95% 0.17 - 1.43, P =0.20). Median time-to-treatment was 4 days (IQR 3 -5.5). There was a statistically significant difference between the time-to-treatment by initial assessment medium (H (2) = 24.169, P <0.0001; 2.5 days for text, 4 days for online form and 4.5 days for call). Over 98.0% of users reported understanding remote communication and 89.9% would use the service again.

Conclusions:

Postal treatment is an acceptable and rapid treatment option for uncomplicated genital chlamydia. Clinical assessment by text message before online prescription may not be accurate or sufficient. As health care is delivered online, strategies that support safe remote prescribing are increasingly important, as is their evaluation, which should be robust and carefully considered.