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STI initiative: Improving testing for sexually transmitted infections in women
  1. Ryan Christopher Chadwick1,
  2. Kathleen McGregor1,
  3. Paula Sneath1,
  4. Joshua Rempel1,
  5. Betty Li Qun He1,
  6. Allison Brown1,2,
  7. Grant Seifred3,
  8. John McAuley1,3,
  9. Ralph John Kamatovic4,
  10. Muhanad Al-Husari1,3,
  11. Salim Ahmed3,
  12. Monica Bertolo1,3,
  13. Doug Munkley5,
  14. Maynard Luterman1,3
  1. 1 Michael G. DeGroote School of Medicine—Niagara Regional Campus, McMaster University, St. Catharines, Ontario, Canada
  2. 2 Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  3. 3 Ontario Street Medical Centre, St. Catharines, Ontario, Canada
  4. 4 Niagara Walk-in Clinic, Niagara Falls, Ontario, Canada
  5. 5 Morrison Walk-In Medical Clinic, Niagara Falls, Ontario, Canada
  1. Correspondence to Dr. Ryan Christopher Chadwick; ryan.chadwick{at}


Canadian urgent care and walk-in medical clinics provide health care for a population that may be poorly covered by traditional health care structures. Despite evidence suggesting that women with urinary complaints experience a high incidence of sexually transmitted infections (STIs), this population may be under-tested in this particular setting. The aim of this quality improvement initiative was to increase STI testing in women presenting with GU complaints. Implementation of an opt-out method of STI testing for women ages 16 and older was introduced at three walk-in clinics. Women presenting with GU complaints were given the opportunity to provide samples for both conventional urine culture and nucleic acid amplification testing (NAAT) for non-viral STIs. Patients received treatment according to standard of care and public health was notified as per local regulations. Testing rate and STI incidence was tracked via clinic electronic medical records (EMRs). Overall results were tracked using run charts and compared to historical data for the year prior to the start of the project. Over a 1 year period prior to this intervention, only 65 STI tests were performed in over 1100 GU complaints (5.5%). Six STIs were identified during this time. During the 36-week project period, testing increased to 45% of the patient population (320/707). The STI detected incidence increased from 0.51% to 1.4% in all women, and from 0.84% to 3.4% in women aged 16–29 years. An opt-out method was an effective intervention for increasing STI testing within the walk-in clinic setting. With optimisation, significant increases in testing rates can be obtained without substantially increasing clinic workload and at no economic cost to the clinic. As expected, detected incidence rates of STIs were higher than the recognised population prevalence.

  • quality improvement
  • healthcare quality improvement
  • general practice
  • women’s health

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  • Contributors RCC initiated the project, oversaw data collection and performed the literature review, data interpretation and manuscript preparation. KMG, PS, JR and LQH performed data collection and assisted with data interpretation. They also liaised with and trained clinic staff. AB assisted with project design, data interpretation and manuscript preparation. GS, JMA, RJK, MA-H, SA, MB and DM were the clinic physicians who implemented the QI procedures in the project’s walk-in clinics. ML was the lead physician on the project. He contributed to project design, liaised with the data collection team and clinic staff and piloted all interventions.

  • Funding This project received funding from the Michael DeGroote School of Medicine Niagara Regional Campus in the form of a Student Research Funding Grant (US$500).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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