Point-of-care testing improves accuracy of STI care in an emergency department
Objectives We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) fo...
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| Veröffentlicht in: | Sexually transmitted infections 2013-09, Vol.89 (6), p.489-494 |
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| creator | Huppert, Jill S Taylor, Regina G St Cyr, Sarah Hesse, Elizabeth A Reed, Jennifer L |
| description | Objectives We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED). Methods We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14–21 for whom an STI test was ordered. We generated Shewhart control charts and compared overtreatment and undertreatment rates for gonorrhoea and trichomoniasis using χ2 testing. Results Of 1877 visits over 18 months, 8.8% of women had gonorrhoea and 16.5% had trichomoniasis. Overtreatment was higher for women with gonorrhoea than trichomoniasis (54% vs 23%, p |
| doi_str_mv | 10.1136/sextrans-2012-050994 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1426517478</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1426517478</sourcerecordid><originalsourceid>FETCH-LOGICAL-b375t-ef4f49ecf57fd2f862239ff9e363f180a0bd1b1b08758c0ced5efe37c965d38e3</originalsourceid><addsrcrecordid>eNqNkMtKxDAUhoMo3t9ApODGTTT3tEsRLwODCuo6pOnJ0GGajkkrztubcdSFK1fnwPnOz8-H0AklF5RydZngY4g2JMwIZZhIUlViC-1ToRnmTPHtvHNVYlFpvocOUpoTQpSW1S7aY1xoKoTcRw9PfRsG3HvsbIRigDS0YVa03TL275AK69wYrVsVvS-eXybFF9WGwoYCOogzCPnWwNLGoYMwHKEdbxcJjr_nIXq9vXm5vsfTx7vJ9dUU11zLAYMXXlTgvNS-Yb5UjPHK-wq44p6WxJK6oTWtSall6YiDRoIHrl2lZMNL4IfofJOba76NubTp2uRgsbAB-jEZKpiSVAtdZvTsDzrvxxhyO0N1STVTiuhMiQ3lYp9SBG-Wse1sXBlKzNq3-fFt1r7Nxnd-O_0OH-sOmt-nH8EZuNwAdTf_X-QnOmyNDw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1781726607</pqid></control><display><type>article</type><title>Point-of-care testing improves accuracy of STI care in an emergency department</title><source>BMJ Journals Online Archive</source><source>MEDLINE</source><creator>Huppert, Jill S ; Taylor, Regina G ; St Cyr, Sarah ; Hesse, Elizabeth A ; Reed, Jennifer L</creator><creatorcontrib>Huppert, Jill S ; Taylor, Regina G ; St Cyr, Sarah ; Hesse, Elizabeth A ; Reed, Jennifer L</creatorcontrib><description>Objectives We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED). Methods We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14–21 for whom an STI test was ordered. We generated Shewhart control charts and compared overtreatment and undertreatment rates for gonorrhoea and trichomoniasis using χ2 testing. Results Of 1877 visits over 18 months, 8.8% of women had gonorrhoea and 16.5% had trichomoniasis. Overtreatment was higher for women with gonorrhoea than trichomoniasis (54% vs 23%, p<0.001). Overtreatment for gonorrhoea decreased from 58% to 47% (p<0.01) and overtreatment for trichomoniasis decreased from 24% to 18% (p<0.01), which corresponded to improvements in patient follow-up for the QI project. Undertreatment was higher for women with gonorrhoea than trichomoniasis (29% vs 21%, p=0.03), and did not change over time. Conclusions A POC test improves the accuracy of STI care in an ED compared with NAAT testing. An unanticipated benefit of QI efforts to improve patient follow-up is the observed decrease in antibiotic use in the ED. Given the ability of gonorrhoea to develop antibiotic resistance, future efforts should focus on development of an accurate POC test for gonorrhoea.</description><identifier>ISSN: 1368-4973</identifier><identifier>EISSN: 1472-3263</identifier><identifier>DOI: 10.1136/sextrans-2012-050994</identifier><identifier>PMID: 23471445</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Accuracy ; Adolescent ; Antibiotics ; Antigens ; Drug resistance ; Emergency Medical Services - methods ; Female ; Gonorrhea ; Gonorrhea - diagnosis ; Gonorrhea - drug therapy ; Health Services Research ; Humans ; Infections ; Laboratories ; Point-of-Care Systems ; Sexually transmitted diseases ; Sexually Transmitted Diseases - diagnosis ; Sexually Transmitted Diseases - drug therapy ; STD ; Trichomonas Infections - diagnosis ; Trichomonas Infections - drug therapy ; Urine ; Young Adult</subject><ispartof>Sexually transmitted infections, 2013-09, Vol.89 (6), p.489-494</ispartof><rights>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2013 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b375t-ef4f49ecf57fd2f862239ff9e363f180a0bd1b1b08758c0ced5efe37c965d38e3</citedby><cites>FETCH-LOGICAL-b375t-ef4f49ecf57fd2f862239ff9e363f180a0bd1b1b08758c0ced5efe37c965d38e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://sti.bmj.com/content/89/6/489.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttps://sti.bmj.com/content/89/6/489.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,3196,23571,27924,27925,77600,77631</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23471445$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Huppert, Jill S</creatorcontrib><creatorcontrib>Taylor, Regina G</creatorcontrib><creatorcontrib>St Cyr, Sarah</creatorcontrib><creatorcontrib>Hesse, Elizabeth A</creatorcontrib><creatorcontrib>Reed, Jennifer L</creatorcontrib><title>Point-of-care testing improves accuracy of STI care in an emergency department</title><title>Sexually transmitted infections</title><addtitle>Sex Transm Infect</addtitle><description>Objectives We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED). Methods We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14–21 for whom an STI test was ordered. We generated Shewhart control charts and compared overtreatment and undertreatment rates for gonorrhoea and trichomoniasis using χ2 testing. Results Of 1877 visits over 18 months, 8.8% of women had gonorrhoea and 16.5% had trichomoniasis. Overtreatment was higher for women with gonorrhoea than trichomoniasis (54% vs 23%, p<0.001). Overtreatment for gonorrhoea decreased from 58% to 47% (p<0.01) and overtreatment for trichomoniasis decreased from 24% to 18% (p<0.01), which corresponded to improvements in patient follow-up for the QI project. Undertreatment was higher for women with gonorrhoea than trichomoniasis (29% vs 21%, p=0.03), and did not change over time. Conclusions A POC test improves the accuracy of STI care in an ED compared with NAAT testing. An unanticipated benefit of QI efforts to improve patient follow-up is the observed decrease in antibiotic use in the ED. Given the ability of gonorrhoea to develop antibiotic resistance, future efforts should focus on development of an accurate POC test for gonorrhoea.</description><subject>Accuracy</subject><subject>Adolescent</subject><subject>Antibiotics</subject><subject>Antigens</subject><subject>Drug resistance</subject><subject>Emergency Medical Services - methods</subject><subject>Female</subject><subject>Gonorrhea</subject><subject>Gonorrhea - diagnosis</subject><subject>Gonorrhea - drug therapy</subject><subject>Health Services Research</subject><subject>Humans</subject><subject>Infections</subject><subject>Laboratories</subject><subject>Point-of-Care Systems</subject><subject>Sexually transmitted diseases</subject><subject>Sexually Transmitted Diseases - diagnosis</subject><subject>Sexually Transmitted Diseases - drug therapy</subject><subject>STD</subject><subject>Trichomonas Infections - diagnosis</subject><subject>Trichomonas Infections - drug therapy</subject><subject>Urine</subject><subject>Young Adult</subject><issn>1368-4973</issn><issn>1472-3263</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkMtKxDAUhoMo3t9ApODGTTT3tEsRLwODCuo6pOnJ0GGajkkrztubcdSFK1fnwPnOz8-H0AklF5RydZngY4g2JMwIZZhIUlViC-1ToRnmTPHtvHNVYlFpvocOUpoTQpSW1S7aY1xoKoTcRw9PfRsG3HvsbIRigDS0YVa03TL275AK69wYrVsVvS-eXybFF9WGwoYCOogzCPnWwNLGoYMwHKEdbxcJjr_nIXq9vXm5vsfTx7vJ9dUU11zLAYMXXlTgvNS-Yb5UjPHK-wq44p6WxJK6oTWtSall6YiDRoIHrl2lZMNL4IfofJOba76NubTp2uRgsbAB-jEZKpiSVAtdZvTsDzrvxxhyO0N1STVTiuhMiQ3lYp9SBG-Wse1sXBlKzNq3-fFt1r7Nxnd-O_0OH-sOmt-nH8EZuNwAdTf_X-QnOmyNDw</recordid><startdate>201309</startdate><enddate>201309</enddate><creator>Huppert, Jill S</creator><creator>Taylor, Regina G</creator><creator>St Cyr, Sarah</creator><creator>Hesse, Elizabeth A</creator><creator>Reed, Jennifer L</creator><general>BMJ Publishing Group LTD</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>201309</creationdate><title>Point-of-care testing improves accuracy of STI care in an emergency department</title><author>Huppert, Jill S ; Taylor, Regina G ; St Cyr, Sarah ; Hesse, Elizabeth A ; Reed, Jennifer L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b375t-ef4f49ecf57fd2f862239ff9e363f180a0bd1b1b08758c0ced5efe37c965d38e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Accuracy</topic><topic>Adolescent</topic><topic>Antibiotics</topic><topic>Antigens</topic><topic>Drug resistance</topic><topic>Emergency Medical Services - methods</topic><topic>Female</topic><topic>Gonorrhea</topic><topic>Gonorrhea - diagnosis</topic><topic>Gonorrhea - drug therapy</topic><topic>Health Services Research</topic><topic>Humans</topic><topic>Infections</topic><topic>Laboratories</topic><topic>Point-of-Care Systems</topic><topic>Sexually transmitted diseases</topic><topic>Sexually Transmitted Diseases - diagnosis</topic><topic>Sexually Transmitted Diseases - drug therapy</topic><topic>STD</topic><topic>Trichomonas Infections - diagnosis</topic><topic>Trichomonas Infections - drug therapy</topic><topic>Urine</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huppert, Jill S</creatorcontrib><creatorcontrib>Taylor, Regina G</creatorcontrib><creatorcontrib>St Cyr, Sarah</creatorcontrib><creatorcontrib>Hesse, Elizabeth A</creatorcontrib><creatorcontrib>Reed, Jennifer L</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest_Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest Science Journals</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Sexually transmitted infections</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huppert, Jill S</au><au>Taylor, Regina G</au><au>St Cyr, Sarah</au><au>Hesse, Elizabeth A</au><au>Reed, Jennifer L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Point-of-care testing improves accuracy of STI care in an emergency department</atitle><jtitle>Sexually transmitted infections</jtitle><addtitle>Sex Transm Infect</addtitle><date>2013-09</date><risdate>2013</risdate><volume>89</volume><issue>6</issue><spage>489</spage><epage>494</epage><pages>489-494</pages><issn>1368-4973</issn><eissn>1472-3263</eissn><abstract>Objectives We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED). Methods We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14–21 for whom an STI test was ordered. We generated Shewhart control charts and compared overtreatment and undertreatment rates for gonorrhoea and trichomoniasis using χ2 testing. Results Of 1877 visits over 18 months, 8.8% of women had gonorrhoea and 16.5% had trichomoniasis. Overtreatment was higher for women with gonorrhoea than trichomoniasis (54% vs 23%, p<0.001). Overtreatment for gonorrhoea decreased from 58% to 47% (p<0.01) and overtreatment for trichomoniasis decreased from 24% to 18% (p<0.01), which corresponded to improvements in patient follow-up for the QI project. Undertreatment was higher for women with gonorrhoea than trichomoniasis (29% vs 21%, p=0.03), and did not change over time. Conclusions A POC test improves the accuracy of STI care in an ED compared with NAAT testing. An unanticipated benefit of QI efforts to improve patient follow-up is the observed decrease in antibiotic use in the ED. Given the ability of gonorrhoea to develop antibiotic resistance, future efforts should focus on development of an accurate POC test for gonorrhoea.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>23471445</pmid><doi>10.1136/sextrans-2012-050994</doi><tpages>6</tpages></addata></record> |
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| subjects | Accuracy Adolescent Antibiotics Antigens Drug resistance Emergency Medical Services - methods Female Gonorrhea Gonorrhea - diagnosis Gonorrhea - drug therapy Health Services Research Humans Infections Laboratories Point-of-Care Systems Sexually transmitted diseases Sexually Transmitted Diseases - diagnosis Sexually Transmitted Diseases - drug therapy STD Trichomonas Infections - diagnosis Trichomonas Infections - drug therapy Urine Young Adult |
| title | Point-of-care testing improves accuracy of STI care in an emergency department |
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