Kaiser Permanente study finds patients using the online testing portal were significantly more likely to be diagnosed with an infection than other patients seeking testing
Adults who ordered their own sexually transmitted infection (STI) tests through the Kaiser Permanente Northern California (KPNC) patient portal were more likely to belong to groups at elevated risk for infection — and far more likely to test positive — according to a new Kaiser Permanente study.
The research, published in Clinical Infectious Diseases, found that close to 15% of e-visit users received positive test results.
In contrast, close to 3% of patients who had STI testing after seeing their doctor in person, calling or emailing to request STI testing, or had standard labs fulfilled had positive test results.
“Our study tells us that the STI e-visits we established are reaching the right people, and being used by the patients who need them most,” said co-lead author Dana Clutter, MD, an infectious diseases physician with The Permanente Medical Group (TPMG). “By identifying these STIs and getting these patients treatment, we help not only the patients but also other people at risk for infection.”
Removing hurdles
People seeking STI testing typically go to a primary care physician or to a county sexual health clinic, where a clinician takes a sexual history before ordering tests and collecting samples. Yet, said co-lead author Amanda Thornton, MD, a TPMG infectious disease specialist, we know that “telling a doctor about your sex life isn’t easy for everyone.”
As the COVID-19 pandemic moved more aspects of medicine online, Thornton and her colleagues in infectious disease medicine saw an opportunity to sidestep some of those hurdles by moving STI testing out of the physician’s office. After months of planning, in February 2022, their vision was realized with the launch of a new STI e-visit service.
Now, 24 hours a day, 7 days a week, a KPNC member can go online, answer a short questionnaire, and select which infections they want to be tested for. The lab orders are placed automatically, and the person seeking testing can visit any KPNC laboratory to have samples collected. Test results route to a physician’s inbox for review, a summary of the encounter appears in the member’s chart, and if treatment is needed, medications can be picked up at a KPNC pharmacy or mailed to the patient’s home.
“It levels out the services we provide to our members,” said senior author Jacek Skarbinski, MD, a research scientist with the Kaiser Permanente Division of Research and an infectious diseases and HIV medicine specialist. “Whether you live in Modesto and have a long drive to a medical facility or in San Francisco and Kaiser Permanente is nearby, you can go online and get the care you need, privately and safely.”
Reaching higher-risk patients
The researchers compared about 150,000 e-visit users with nearly 830,000 members who made an appointment for STI testing between 2022 and 2024. Their analyses showed that the patients who used the e-visits were younger, more likely to be male, and more likely to be Black. E-visit users were also more than twice as likely to have previously been diagnosed with an STI.
“It was reassuring that our higher-risk patients found the e-visits worked well for them,” said Thornton. “The program we created is helping them to have their infections caught early.”
The STI e-visit questionnaire was designed to encourage comprehensive testing, including testing for STIs which may initially have minimal symptoms.
For example, the e-visit automatically co-tests for syphilis; HIV screening is opt-out rather than opt-in; and throat and rectal swabs are presented as options for every user. The e-visit tool also educates users about, and allows them to request, HIV preexposure prophylaxis (PrEP).
The researchers said evaluating how the e-visits were used will help them look at ways the program might expand. They noted, for example, that the study found Hispanic and Latino members were less likely to use the e-visit for STI testing than White members, which suggests efforts may need to focus on increasing awareness that the service is available in Spanish. They also want to tease out whether the e-visit option is increasing the overall number of people being tested for STIs.
“When you build something, you never know if it’s actually going to work,” Skarbinski said. “It is very exciting that the STI e-visit has proven so effective.”
The study was funded by The Permanente Medical Group Delivery Science and Applied Research Program.
Co-authors include Yuching Ni, MS, Crystal Hsaio, MPH, Michael Silverberg, PhD, MPH, and Joshua Nugent, PHD, of the Division of Research; and Jonathan Volk, MD, MPH, Christine Bruno, PharmD, Christian Lee-Rodriguez, MD, Mitchell Luu, MD, David Vinson, MD, and Anne Srisuro, MD, of The Permanente Medical Group.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. KPDOR seeks to understand the determinants of illness and well-being and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 720-plus staff, including 73 research and staff scientists, are working on nearly 630 epidemiological and health services research projects. For more information, visit divisionofresearch.kp.org.
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