Sex, stigma and disruption


Disruptive technology can help improve the patient experience, write Liam Murphy and Jackie Eyles

There is no denying that the status quo of current healthcare practice is in the grip of disruption. The key ingredients in this evolution-shaping cocktail include economic pressures, advancements in technology, the ease with which health information can be accessed online and viral commentary on social media platforms.

One prominent example of the last ingredient we saw was last year when an online article by a disgruntled customer sparked discussion surrounding pharmacist provision of the emergency contraceptive/morning after pill. This woman was unhappy about the fact her husband was unable to get this medication on her behalf, delaying treatment and forcing her to take time from her busy schedule to visit a pharmacy herself.

The patient experience is a cornerstone of pharmacy practice, and in this case the woman was left feeling dissatisfied. She was disappointed as there was no service or information given in person that could not have been conveyed through a phone call, which led her to publicly question the process.

Externally, the knee-jerk reaction from the pharmacy industry was to defend itself. A positive aspect was that it forced pharmacists to reassess and discuss the procedures surrounding the morning after pill and why they are so.

Justifications for having a patient interaction with those seeking emergency contraception is that pharmacists can assess that it is appropriate to take, provide counselling and offer relevant referral for sexual assault and sexual health services.

If we look at the role technology may play in disruption, there is potential to streamline processes and improve access to services. One example of a service that pharmacists may consider referring an emergency contraception (or any other) patient to is an initiative that was recently launched by the start up company Stigma Health. They have created an online platform that, in their words, provides a ‘simple, cost effective, convenient and shame-free’ sexual health screening process.

As youth news outlet Pedestrian put it: “You can now bypass awks doc appts & find out if you have an STI via SMS.”

For a patient to access this service, there are a few steps to follow:

First thing is to provide basic personal details on their website and purchase a personalised pathology test referral ($19.99+GST).

Once this has been processed, patients are required to download the MediRecords smartphone app and go to a pathology centre that suits.

The pathology centre tests for Chlamydia, Gonorrhoea, Syphilis, Hepatitis A, B & C and HIV. Assuming the patient has a Medicare card, these tests should be bulk billed.

A notification is sent to patients by SMS that results are ready within 3 -5 business days. Patients can then access the results by the secure app.

Patients that tested positive to any STIs are given information from Stigma Health about their diagnosis and the treatment. Patients are either referred onto their doctor or mailed a prescription to take directly to a pharmacy. There is technology available to send a QR code straight to the phone app but legislation changes are needed to allow for this.

This service provides a niche alternative compared to the current options for those seeking STI screening. By reducing some of the barriers and stigma surrounding sexual health screening, it may help encourage people to get tested and treated when required.

With the 2016 Kirby Report indicating that a majority of Chlamydia infections remain undiagnosed and therefore untreated, any initiative to encourage testing should be embraced.

Despite there being positive aspects of this concept, this service isn’t for everyone and before professionally referring patients onto it, the limitations of bypassing a GP or sexual health clinician need to be considered.

“For starters, this model of care in no way addresses the potential for emotional upset,” says Jackie Eyles, sexual health consultant for The Roaming Pharmacist. Jackie lives and works in the NSW Snowy Mountains as a nurse specialising in youth and sexual health.

In 2013, Jackie set up a bulk-billing sexual health clinic in Jindabyne, NSW called The Wednesday Room to provide a non-judgmental service for the local community and the influx of seasonal residents that come for the snow each winter. Jackie is concerned by the idea that young and vulnerable people may be drawn to the service as it can be less confronting.

However, based on her experience, she believes these patients are the ones that really need to be visiting a clinician. On one hand she acknowledges that this service has the potential to increase testing rates, but she sees sexual health screening as an opportunity to engage with patients and open up a discussion about their health.

In her words, “seeing a clinician gives the opportunity for other health matters to be identified. Most notably this includes mental health support, the need for pharmaceuticals and/or immunisation. Patients may also need to be linked into other health services.”

Being an online format, the scope of what can be tested for is also limited. This service does not test for conditions such as HPV and genital herpes. This means that patients presenting with any physical symptoms, such as lesions, should be directed straight to a clinician.

The website also advises patients that believe they may have been exposed to Hepatitis B or HIV in the 72 hours prior to seek immediate medical attention. Pregnancy testing and counselling are also outside of the scope of the screening.

A service like that offered by Stigma Health may be beneficial to improve testing rates, and hopefully it fulfils this purpose, but it can’t be solely relied upon to improve the overall picture. James Sneddon, the Director of Stigma Health, sums it up by saying, “We are a screening tool to be used in conjunction with existing service, for suitable patients only.”

There is huge potential for what disruptive services may have in shaping the future of healthcare. This notion is being nurtured by new initiatives like PharmHack, which encourage collaboration between software developers and health professionals to create apps that may well reshape the healthcare industry.

As a clinician, Jackie is passionate about raising the bar of health care provided in Australia, especially for young people. Like the rest of The Roaming Pharmacist team, she wants to break down communication barriers between the public and health professionals and improve health interventions and outcomes.

There are many ways that this can be achieved and although technology will play a role, Jackie firmly believes that encouraging and nurturing patient-clinician relationships is a good place to start.

Liam Murphy is the founder of The Roaming Pharmacist, and Jackie Eyles is a nurse specialising in youth and sexual health.

Stigma Health has responded to some of the claims in this article. Read their response here.

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