Skip to main content
NCBI home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2004 Jun;80(3):223–229. doi: 10.1136/sti.2003.005165

Developing national outcome standards for the management of gonorrhoea and genital chlamydia in genitourinary medicine clinics

N Low 1, J Welch 1, K Radcliffe 1
PMCID: PMC1744841  PMID: 15170010

Abstract

Background: Measuring clinical performance within a framework of clinical governance is increasingly important for monitoring improvements in patient care. Standards for quality indicators must, however, be achievable and evidence based. We describe an approach to the development of national standards for measuring outcomes of care for gonorrhoea and genital chlamydia in genitourinary medicine clinics.

Methods: Two standards for each infection, one reflecting quality of case management and one reflecting partner management were chosen by consensus. A systematic review of published and unpublished UK studies about gonorrhoea and chlamydia management was carried out and weighted averages calculated for each parameter, stratified by location. Genitourinary medicine practitioners around the country were also asked for their opinion about desirable values for each standard and the results compared. Variability in performance between centres was examined using Shewhart's control charts.

Results: We identified 17 reports about gonorrhoea outcomes and 14 about chlamydia. There was marked heterogeneity in results according to geographical location and different standards were set for clinics in and out of London. Opinions from practitioners suggested much higher standards than the values obtained from the systematic review. There was evidence for special cause variation related to management of gonorrhoea and chlamydia in London clinics.

Conclusions: Standards set using expert opinion are unrealistic when compared to evidence of what is achievable. Evidence based methods should therefore be used to derive outcome standards for case management gonorrhoea and chlamydia. The control chart method identified clinics where investigation to find reasons for special cause variation in performance should be undertaken to change practice.

Full Text

The Full Text of this article is available as a PDF (121.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bell G., Ward H., Day S., Ghani A. C., Goan U., Claydon E., Kinghorn G. R. Partner notification for gonorrhoea: a comparative study with a provincial and a metropolitan UK clinic. Sex Transm Infect. 1998 Dec;74(6):409–414. doi: 10.1136/sti.74.6.409. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Campbell S. M., Braspenning J., Hutchinson A., Marshall M. Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care. 2002 Dec;11(4):358–364. doi: 10.1136/qhc.11.4.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Clarke J., Preston A. D. A multi-district audit against national guidelines for the management of uncomplicated genital Chlamydia trachomatis infection. Int J STD AIDS. 2001 Oct;12(10):677–686. doi: 10.1258/0956462011923912. [DOI] [PubMed] [Google Scholar]
  4. Dale A. W., Horner P. J., Forster G. E., Daniels D., Tomlinson D., Brook M. G., North Thames GUM/HIV Audit Group Management of Chlamydia trachomatis genital tract infection in Genitourinary Medicine clinics in the United Kingdom's North Thames Region 1999. Int J STD AIDS. 2001 Mar;12(3):204–208. doi: 10.1258/0956462011916910. [DOI] [PubMed] [Google Scholar]
  5. David L. M., Wade A. A., Natin D., Radcliffe K. W. Gonorrhoea in Coventry 1991-1994: epidemiology, coinfection and evaluation of partner notification in the STD clinic. Int J STD AIDS. 1997 May;8(5):311–316. doi: 10.1258/0956462971920154. [DOI] [PubMed] [Google Scholar]
  6. Elawad B. B., White C. Would you get your Gonorrhoea treated in the north of England? Int J STD AIDS. 2001 Feb;12(2):122–125. doi: 10.1258/0956462011916767. [DOI] [PubMed] [Google Scholar]
  7. Fahey T. P., Peters T. J. What constitutes controlled hypertension? Patient based comparison of hypertension guidelines. BMJ. 1996 Jul 13;313(7049):93–96. doi: 10.1136/bmj.313.7049.93. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. FitzGerald M. R., Thirlby D., Bedford C. A. The outcome of contact tracing for gonorrhoea in the United Kingdom. Int J STD AIDS. 1998 Nov;9(11):657–660. doi: 10.1258/0956462981921305. [DOI] [PubMed] [Google Scholar]
  9. Jarvis R. R., Curless E., Considine K. Outcome of contact tracing for Chlamydia trachomatis in a district general hospital. Int J STD AIDS. 1999 Apr;10(4):250–253. doi: 10.1258/0956462991914023. [DOI] [PubMed] [Google Scholar]
  10. Lewis D. A., Bond M., Butt K. D., Smith C. P., Shafi M. S., Murphy S. M. A one-year survey of gonococcal infection seen in the genitourinary medicine department of a London district general hospital. Int J STD AIDS. 1999 Sep;10(9):588–594. doi: 10.1258/0956462991914717. [DOI] [PubMed] [Google Scholar]
  11. McColl A., Roderick P., Gabbay J., Smith H., Moore M. Performance indicators for primary care groups: an evidence based approach. BMJ. 1998 Nov 14;317(7169):1354–1360. doi: 10.1136/bmj.317.7169.1354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mohammed M. A., Cheng K. K., Rouse A., Marshall T. Bristol, Shipman, and clinical governance: Shewhart's forgotten lessons. Lancet. 2001 Feb 10;357(9254):463–467. doi: 10.1016/s0140-6736(00)04019-8. [DOI] [PubMed] [Google Scholar]
  13. Monteiro E. F., Harris J., Gilliatt P. A multidistrict audit on the management of Chlamydia trachomatis in genitourinary medicine clinics in Yorkshire. Int J STD AIDS. 1997 Dec;8(12):792–795. doi: 10.1258/0956462971919147. [DOI] [PubMed] [Google Scholar]
  14. Priestley C. J. The management of Chlamydia trachomatis genital infection in genitourinary medicine clinics in the Wessex region. Int J STD AIDS. 1998 Feb;9(2):117–120. doi: 10.1258/0956462981921675. [DOI] [PubMed] [Google Scholar]
  15. Rogstad K. E., Clementson C., Ahmed-Jushuf I. H. Contact tracing for gonorrhoea in homosexual and heterosexual men. Int J STD AIDS. 1999 Aug;10(8):536–538. [PubMed] [Google Scholar]
  16. Ross J. D., Sukthankar A., Radcliffe K. W., Andre J. Do the factors associated with successful contact tracing of patients with gonorrhoea and Chlamydia differ? Sex Transm Infect. 1999 Apr;75(2):112–115. doi: 10.1136/sti.75.2.112. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Shekelle P. G., Woolf S. H., Eccles M., Grimshaw J. Clinical guidelines: developing guidelines. BMJ. 1999 Feb 27;318(7183):593–596. doi: 10.1136/bmj.318.7183.593. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Sonnex C., Williams O. The management of chlamydial infection: setting standards at a regional level. Int J STD AIDS. 1998 Oct;9(10):600–603. doi: 10.1258/0956462981921198. [DOI] [PubMed] [Google Scholar]
  19. Watson P. G. Using a national guideline: an audit of the management of gonorrhoea in Newcastle upon Tyne. Int J STD AIDS. 2000 Oct;11(10):677–681. doi: 10.1258/0956462001915057. [DOI] [PubMed] [Google Scholar]
  20. White C., Wardropper A. G. Chlamydia in a district general hospital: an audit of treatment and contact tracing. Int J STD AIDS. 1999 Jan;10(1):57–59. doi: 10.1258/0956462991912953. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES