Lwegaba A, Kilaru K
Cave Hill, The University of the West Indies, Barbados.
West Indian Med J. 2009 Nov;58(5):476-84.
To measure the quality of the clinical Genitourinary (G-U) Medicine and Sexually Transmitted Infection (GUM/STI) management process at a primary care polyclinic and establish a baseline for future monitoring and evaluation.
This was a prospective cohort study on 220 data abstracted clinical notes randomly selected and stratified by gender, age and first point of contact from 2131 GU/STI patients of the GUM/STI clinic seen from 2003-5. Data were also obtained by tele-interview of a subset of 27 individuals. Measurements were incidence (95% CI) as proportions of successful level of activity and outcome indicators for diagnosis, treatment and prognosis.
Among 220 patients, the incidence (95% CI) of accurate clinical diagnosis and treatment was 40.5% (33%, 46%) before laboratory results boosted it to 96% (93%, 99%). Successful prognosis at 1st, 2nd and 3rd follow-up was 23.2%, 56.6% and 86.2%. The risk at follow-up for 1, 2 and >2 GU/STI episodes was 28.9%, 45.8% and 25.3%. Follow-up of partners was low, 4.7%. Adequate health promotion and preventive services were reported in 86.5% (78%, 88%) of 220 patients' records and by 84.5% (71%, 98%) of 26 who were tele-interviewed. In 88.5% (76%, 100%) of those (27) tele-interviewed, there was satisfaction with the service, but 73.8% (56%, 90%) would have preferred appointments and 29.6% (12%, 47%) preferred extended hours. Per capita ideal cost of medication could have been BB$6.30 (+/- 1.56) instead of actual BB$13.05 (+/- 1.84); (BB$2 = US$1).
GU/STI quality performance improvement in Barbados requires rapid laboratory diagnosis, standardized data formats with prompt expedited partner notification and treatment appointments and use of recommended algorithm that can half the cost of medication. Genitourinary medicine should be strategized instead of STI to better encapsulate the spectrum diversity of presentations and points of service.
评估一家基层医疗综合诊所的临床泌尿生殖医学及性传播感染（GUM/STI）管理流程质量，并为未来的监测与评估建立基线。
这是一项前瞻性队列研究，从2003年至2005年期间就诊于GUM/STI诊所的2131例GU/STI患者中，随机抽取220份数据摘要临床记录，并按性别、年龄和首次接触点进行分层。还通过电话访谈了27名患者的子集获取数据。测量指标为发病率（95%置信区间），以诊断、治疗和预后的活动成功水平及结果指标的比例表示。
在220例患者中，准确临床诊断和治疗的发病率（95%置信区间）在实验室结果提升之前为40.5%（33%，46%），之后提升至96%（93%，99%）。第一次、第二次和第三次随访时的成功预后分别为23.2%、56.6%和86.2%。随访时发生1次、2次及>2次GU/STI发作的风险分别为28.9%、45.8%和25.3%。性伴侣随访率较低，为4.7%。在220例患者记录中，86.5%（78%，88%）报告有充分的健康促进和预防服务；在接受电话访谈的26例患者中，84.5%（71%，98%）报告有此类服务。在接受电话访谈的27例患者中，88.5%（76%，100%）对服务满意，但73.8%（56%，90%）希望能预约就诊，29.6%（12%，47%）希望延长服务时间。人均理想药物成本本可为巴巴多斯元6.30（±1.56），而非实际的巴巴多斯元13.05（±1.84）；（2巴巴多斯元 = 1美元）。
巴巴多斯改善GU/STI质量表现需要快速的实验室诊断、标准化的数据格式、及时的性伴侣通知和治疗预约，以及使用可使药物成本减半的推荐算法。泌尿生殖医学应制定战略规划而非仅关注性传播感染，以更好地涵盖临床表现和服务点的多样性。
