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.
