Developing eSexual Health within the NHS How can we optimally design, implement and evaluate an internet-based clinical pathway for remote testing, diagnosis, clinical assessment, antibiotic prescribing and partner management of sexually transmitted infections?

Abstract

Over the past 20 years, the incorporation of eHealth within health services in England has expanded organically in diverse ways, usually in response to local perceived need, interest or funding. UK government policy and strategies have taken an optimistic view of how eHealth can revolutionise publically funded health care provision and implementation lags far behind expectations. Although there are some excellent examples of how eHealth has been incorporated into NHS practice in a beneficial manner, there is also a concerning lack of evidence to support many of the interventions and new models of service delivery. This largely reflects a disparate and fragmented evidence base within current eHealth literature, particularly in relation to methods for developing online care pathways. This doctoral research is focused on developing and implementing an online automated clinical care pathway for people with genital chlamydia infection, and developing a robust framework for its evaluation. The care pathway is a core component of an eSexual Health Clinic, also developed as part of this work, which is fully integrated within an NHS specialist sexual health service. An online clinical pathway taking a person from diagnosis of a new condition, through an automated clinical consultation, partner notification and collection of antibiotics from a community pharmacy via an electronic prescription has never been done before in the UK. The novelty of the work and paucity of literature in this field at times necessitated a different approach from conventional research practice. I started by conducting a scoping review to identify the legal, regulatory, ethical and perceptual barriers to introducing such a pathway into the NHS. Electronic prescribing across the secondary and primary care interface stood out as a barrier to implementation. There was also a clear lack of evidence in terms of the content and accuracy of sexual health mobile medical applications. I went on to conduct detailed reviews of both of these areas. 3 In the absence of any relevant guidance on developing online clinical care pathways, I then developed my own methods, underpinned by evidence adapted from guidance aimed at traditional clinical care, existing protocols and practice, eHealth and sexual health literature and questionnaires, and created a new eClinical Care Pathway Framework. I then applied this framework to guide my development of the online clinical care pathway for people with genital chlamydia. We then needed to demonstrate that the Chlamydia online clinical care pathway was feasible, acceptable and safe to take forward into a large scale trial, and potentially implement into clinical practice. There are no accepted methods for evaluation of this type of online clinical care pathway and my final piece of work focussed on developing a set of evaluation techniques and activities, which would assess all these elements to determine whether the online pathway was fit for purpose. Outputs of this doctoral work include: a comprehensive review of contemporary sexually transmitted infection and sexual health mobile applications (apps); a comprehensive review of electronic prescribing in the UK; a method for developing complex online clinical care pathways based on a novel framework; UK’s first automated online clinical care pathway for people with genital chlamydia, and finally a method for evaluation of online clinical care pathways.