2010 BASHH NATIONAL RE-AUDIT ON SEXUAL HISTORY TAKING A Sullivan, H McClean, C Carne, S Tayal, D Daniels September 2010

Case note audit against standards and recommendations in the BASHH 2006 National Guidelines – consultations requiring sexual history-taking. Comparisons made to the baseline 2008 National Audit of Sexual History taking

Number of clinics * Number of patients Male2079 (49%)2061 (50%) Female2206 (51%)2060 (50%) Pregnant59 (1%)38 (2%) MSM161 (4%)179 (9%) Demographic data *from all 14 English BASHH regions and Scotland, Wales and Northern Ireland, about 60% of all GU clinics *from all 14 English BASHH regions and Scotland, Wales and Northern Ireland, about 60% of all GU clinics

Auditable outcome measure: The proportion of new/rebooked patients asked about the gender of their last sexual partner (target >95%)

2010 (N=4285)2008 (N=4121) Documentation of gender of most recent partner: Number (%, regional range%) Number % (regional range) Documented4111 (96%, 84–100%)3871 (94%, 85-99%) Not documented148 (3%, 0-16%)209 (5%, 1-14%) Not applicable26 (1%, 0-2%)41 (1%, 0-2%) Gender of the most recent sexual contact

Auditable outcome measure: The proportion of new/rebooked patients asked about condom use at the last sexual intercourse (target >95%)

2010 (n=3817)2008 (n=3896) Having/not having vaginal sex Documented3352 (88%, 67-93%)3192 (82%, 60-94%) Not documented405 (11%, 4-22%)643 (17%, 2-38%) Not applicable60 (2%, 0-11% )61 (2%, 0-3%) Condom use for vaginal sex Documented3385 (89%, 77-95%3345 (86%, 68-94%) Not documented285 (7%, 3-16%)349 (9%, 4-20%) Not applicable147 (4%, 0-15%)202 (5%, 2-22%) Vaginal sex and condom use – Heterosexual men and women

2010 (n=188)2008 (n=204) Giving/not giving anal sex Documented151 (80%, %)163 (80%, %) Not documented32 (17%, 0-60%)7 (17%, 0-38%) Not applicable5 (3%, 0-25%)34 (3%, 0-14%) Receiving/not receiving anal sex Documented153 (81%, %)161 (80%, %) Not documented29 (15%, 0-50%)30 (15%, 0-38%) Not applicable6 (3%, 0-7%)13 (6%, 0-20%) Condom use for anal sex Documented139 (74%, %)144 (71%, 93-44%) Not documented15 (8%, 0-33%)25 (12%, 0-31%) Not applicable34 (18%, 0-44%)35 (17%, 0-50%) Anal sex and condom use – all MSM

2010 (n=2019)2008 (n=2039) Receiving anal sex Documented608 (30%, 4-48%)593 (29%, 4–56%) Not documented1222 (61%, 34-96%)1246 (61%, 42-88%) Not applicable189 (9%, 0-31%)200 (10%, 0-27%) Condom use for anal sex Documented170 (8%, 1-15%) 169 (8%, 1%– 21) Not documented657 (33%, 7-86%)910 (45%, 14-67%) Not applicable1192 (59%, 10-86%)960 (47%, 26-67%) Anal sex and condom use – female heterosexual cases* *includes only those cases with documented heterosexuality

Auditable outcome measure: New/rebooked patients should have comprehensive histories taken and legibly recorded (Target >90%) GMC states: Wherever possible, you should offer a chaperone during an intimate examination

2010 (N=4285)2008 (N=4121) Chaperone offered Female(n=2206)(n=2060) Documented1405 (64%, 43-81%)1165 (57%, 16-82%) Not documented565 (26%, 11-48%)631 (31%, 8-50%) Not applicable236 (11%, 0-21%)264 (13%, 2-36%) Male(n=2079)(n=2061) Documented1233 (59%, 85-42%)1041 (51%, 24-88%) Not documented680 (33%, 11-50%)809 (39%, 9-72%) Not applicable166 (8%, 2-18%)211 (10%, 2-22%) Record legibility Legible3704 (86%, %)3914 (95%, %) Not legible85 (2%, 0-8%)118 (3%, 0-9%) Electronic496 (12%, 0-40*%) 89 (2%, 0-17%) Offer of chaperone and legibility *Scotland

Auditable outcome: An HIV risk assessment should be taken in all new/rebooked patients (>90%) This is described in the Guidelines as having six components: three of these were re-audited

Components of the HIV risk assessment History of IDU Female n=2206, male n=2079 Female n=2060, male n=2061 FemaleDocumented1878 (85%, 52-99%)1639 (80%, 57-97%) Not documented293 (13%, 1-48%) 393 (19%, 2-43%) Not applicable35 (2%, 0-5%) 28 (1%, 0-4%) MaleDocumented1879 (90%, %)1654 (80%, 48-97%) Not documented189 (9%, 0-46%) 380 (18%, 1-50%) Not applicable11 (1%, 0-3%) 27 (1%, 0-7%) Sex abroad Female n=2206, male n=2079 Female n=2060, male n=2061 FemaleDocumented1694 (77%, 50-94%) 1246 (61%, 30-92%) Not documented476 (22%, 1-50%) 730 (35%, 4-55%) Not applicable36 (2%, 0-4%) 84 (4%, 0-17%) MaleDocumented1685 (81%, 46-93%) 1278 (62%, 35-97%) Not documented381 (18%, 5-54%) 709 (34%, 3-57%) Not applicable13 (1%, 0-3%) 74 (4%, 0-11%) Sex with a man (heterosexual men) n= 1798 n=1857 Documented1457 (81%, 52-94%) 1267 (68%, 46-90%) Not documented253 (14%, 1-45%)430 (23%, 1-54%) Not applicable88 (5%, 1-12%)160 (9%, 0-23%) HIV risk assessment

The Guidelines indicate all individuals should be asked about ‘problems or symptoms of last sexual partner’

Symptoms/risk recording 2010 Female n=2206, male n= Female n=2060, male n=2061 Presence or absence of symptoms in partner FemaleDocumented912 (41%, 23-69%)698 (34%, 15-64%) Not documented1194 (54%, 29-71%)1255 (61%, 32-84%) Not applicable100 (5%, 0-15%)107 (5%, 0-17%) MaleDocumented936 (45%, 26-66%)676 (33%, 11-63%) Not documented1068 (51%, 29-70%)1286 (62%, 36-87%) Not applicable75 (4%, 0-11%)99 (5%, 0-13%) Presence or absence of information on partner risk FemaleDocumented1359 (62%, 30-77%)900 (44%, 18-70%) Not documented764 (35%, 17-67%)1021 (50%, 16-74%) Not applicable83 (4%, 0-13%)139 (7%, 1-20%) MaleDocumented1301 (63% 37-73%)882 (43%, 23-70%) Not documented723 (35%, 25-54%)1057 (51%, 22-76%) Not applicable55 (3%, 0-13%)122 (6%, 0-16%) Partner symptom/risk information

Recommendations of 2008 Baseline Audit Improve recording of the following areas of practice: –Offer of a chaperone –Condom usage –HIV risk assessment

Documentation Target Gender most recent sexual ctactIncrease94%96%95% Chaperone offered100% (GMC) WomenIncrease57%64% MenIncrease51%59% Use of condoms95% Heterosexual casesIncrease86%89% MSMIncrease71%74% HIV risk assessment90% Injecting drug use (men)Increase80%90% Injecting drug use (women)Increase80%85% Sex abroad (men)Increase62%81% Sex abroad (women)Increase61%67% Sex with another manIncrease68%81% Legibility (excluding ECR)Unchanged98%97%90% Electronic care recordsIncrease2%12% mainly Scotland Comparison 2008 vs 2010 (%)

Conclusions and next steps Maintained high level of legibility - target met Met target for recording sex of last partner Improved in areas identified as being of concern from 2008 audit but fell short of target in all areas except for IVDU history in men Regional Audit Chairs to identify clinics with significant improvements and any changes introduced and share best practice Re-audit relevant key points at a local level