2011 - 2012年芝加哥医疗服务提供者对疾病控制与预防中心淋病治疗指南的遵循情况

Adherence to Centers for Disease Control and Prevention Gonococcal Treatment Guidelines Among Chicago Health Care Providers, 2011-2012.

作者信息

Tabidze Irina L, Nicholson Tracy F, Mikati Tarek, Benbow Nanette, Mehta Supriya D

机构信息

From the *Chicago Department of Public Health, Chicago, IL; †Institute of Health Research and Policy, Chicago, IL; and ‡Division of Epidemiology & Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL.

出版信息

Sex Transm Dis. 2015 Aug;42(8):422-8. doi: 10.1097/OLQ.0000000000000310.

DOI:10.1097/OLQ.0000000000000310

PMID:26165433

Abstract

BACKGROUND

Expansion of antimicrobial resistance in Neisseria gonorrhoeae requires rapid adaptation of treatment guidelines and responsive provider practice. We evaluated patient factors associated with provider adherence to the Centers for Disease Control and Prevention gonococcal treatment recommendations among Chicago providers in 2011 to 2012.

METHODS

Laboratory-confirmed cases of uncomplicated urogenital gonorrhea were classified via surveillance data as originating from Chicago Department of Public Health (CDPH) or non-CDPH providers. Recommended treatment was determined according to the Centers for Disease Control and Prevention sexually transmitted disease treatment guidelines: April 2011-July 2012 (period 1) and August-December 2012 (period 2, after August 2012 revision). Multivariable log-binomial regression identified factors associated with recommended treatment over time, stratified by provider type.

RESULTS

April 2011 through December 2012, 16,646 laboratory-confirmed gonorrhea cases were identified, of which 9597 (57.7%) had treatment information: 2169 CDPH cases and 7428 non-CDPH cases. Documented recommended treatment increased for CDPH (period 1: 71.3%, period 2: 80.8%; P < 0.01) and non-CDPH providers (period 1: 63.5%, period 2: 68.9%; P < 0.01). Among CDPH cases, statistically significant factors associated with recommended treatment were male sex (adjusted prevalence rate ratio [aPRR], 1.16) white versus black race (aPRR, 0.68), same-day treatment (aPRR, 1.07), and period 2 (aPRR, 1.11). Among non-CDPH cases, statistically significant factors were as follows: male sex (aPRR, 1.10), other versus black race (aPRR, 0.91), same-day treatment (aPRR, 1.31), greater number of within-facility reported cases (aPRRs ranging from 1.22 to 1.41), and at least 50% within-facility missing treatment data (aPRR, 0.84).

CONCLUSIONS

Recommended treatment improved over time, yet remains suboptimal. Efforts to reduce variability and improve provider adherence to recommended treatment are urgently needed.

摘要

背景

淋病奈瑟菌耐药性的扩大要求迅速调整治疗指南并促使医疗服务提供者做出相应的实践。我们评估了2011年至2012年芝加哥医疗服务提供者中与遵循疾病控制与预防中心淋病治疗建议相关的患者因素。

方法

通过监测数据将实验室确诊的非复杂性泌尿生殖系统淋病病例分类为源自芝加哥公共卫生部（CDPH）或非CDPH的医疗服务提供者。根据疾病控制与预防中心性传播疾病治疗指南确定推荐治疗方案：2011年4月至2012年7月（第1阶段）以及2012年8月至12月（第2阶段，2012年8月修订之后）。多变量对数二项回归确定了随时间推移与推荐治疗相关的因素，并按医疗服务提供者类型进行分层。

结果

2011年4月至2012年12月，共识别出16,646例实验室确诊的淋病病例，其中9597例（57.7%）有治疗信息：2169例CDPH病例和7428例非CDPH病例。CDPH（第1阶段：71.3%，第2阶段：80.8%；P<0.01）和非CDPH医疗服务提供者（第1阶段：63.5%，第2阶段：68.9%；P<0.01）记录的推荐治疗有所增加。在CDPH病例中，与推荐治疗相关的具有统计学意义的因素为男性（调整患病率比[aPRR]，1.16）、白种人与黑种人种族对比（aPRR，0.68）、当日治疗（aPRR，1.07）以及第2阶段（aPRR，1.11）。在非CDPH病例中，具有统计学意义的因素如下：男性（aPRR，1.10）、其他种族与黑种人种族对比（aPRR，0.91）、当日治疗（aPRR，1.31）、机构内报告病例数较多（aPRR范围为1.22至1.41）以及机构内至少50%的治疗数据缺失（aPRR，0.84）。