Importance and feasibility of holistic sexual health care in primary and tertiary care setting in London

A. Oswal (1), R. Chatterjee (2)

Genito urinary medicine and Contraception, Central Middlesex Hospital, London, UK (1); Reproductive medicine unit, University College Hospital, London, UK (2)

Introduction: Unwanted pregnancy, contraceptive and sexual health related problems constitute a significant cause of sexual morbidity, especially in young subjects in the UK. This is at least, partly due to lack of integrated care provided by the clinicians responsible for the care of these patients.

Aims of study: To test the hypothesis that holistic care implemented by a multidisciplinary team of clinicians interfacing between primary, secondary and tertiary setting can improve the total contraceptive, reproductive and sexual care of young patients Patients and Methods: We undertook an observational case control study in a small cohort of 10 clients in 3 geographic areas in West London involving 3 centres. Five clients of the received holistic care (group A), whereas another 5 recruited from other two centres (Group B) received sexual and reproductive care by the community family planning in a primary care setting.

Results: Group B patients had more sexual morbidity compared to Group A. This was due to inconvenience experienced during referrals to different disciplines at distant sites leading to delays with consequent losses in follow up. Failure of the contraceptive clinics to meet the needs of male clients, absence of opportunistic screening, failure in implementation of STI screening or antibiotic cover in clients requesting TOP. These problems were obviated in Group A due to comprehensive work up and holistic care offered by the multidisciplinary team. This small cohort study suggest that holistic care provision yielded a better patient satisfaction, improved risk awareness, increased uptake of screening, earlier diagnosis and treatment, better contraceptive compliance and concordance and decreased sexual morbidity.

Conclusion: Our results show that holistic sexual care offered by a multidisciplinary team of clinicians interfacing between the primary, secondary and tertiary care setting can improve the efficacy of reproductive and sexual health care of young adults in London.