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Sex Transm Infect. Jun 2004; 80(3): 223–229.
PMCID: PMC1744841

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


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 A systematic review of published and unpublished UK studies about gonorrhoea and chlamydia management was carried out and weighted averages calculated for each parameter, stratified by location.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.

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Selected References

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  • Shekelle PG, Woolf SH, Eccles M, Grimshaw J. Clinical guidelines: developing guidelines. BMJ. 1999 Feb 27;318(7183):593–596. [PMC free article] [PubMed]
  • Campbell SM, 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. [PMC free article] [PubMed]
  • 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. [PMC free article] [PubMed]
  • Fahey TP, Peters TJ. What constitutes controlled hypertension? Patient based comparison of hypertension guidelines. BMJ. 1996 Jul 13;313(7049):93–96. [PMC free article] [PubMed]
  • Mohammed MA, Cheng KK, Rouse A, Marshall T. Bristol, Shipman, and clinical governance: Shewhart's forgotten lessons. Lancet. 2001 Feb 10;357(9254):463–467. [PubMed]
  • FitzGerald MR, Thirlby D, Bedford CA. The outcome of contact tracing for gonorrhoea in the United Kingdom. Int J STD AIDS. 1998 Nov;9(11):657–660. [PubMed]
  • David LM, Wade AA, Natin D, Radcliffe KW. 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. [PubMed]
  • Bell G, Ward H, Day S, Ghani AC, Goan U, Claydon E, Kinghorn GR. Partner notification for gonorrhoea: a comparative study with a provincial and a metropolitan UK clinic. Sex Transm Infect. 1998 Dec;74(6):409–414. [PMC free article] [PubMed]
  • Elawad BB, White C. Would you get your Gonorrhoea treated in the north of England? Int J STD AIDS. 2001 Feb;12(2):122–125. [PubMed]
  • Rogstad KE, Clementson C, Ahmed-Jushuf IH. Contact tracing for gonorrhoea in homosexual and heterosexual men. Int J STD AIDS. 1999 Aug;10(8):536–538. [PubMed]
  • Ross JD, Sukthankar A, Radcliffe KW, 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. [PMC free article] [PubMed]
  • Lewis DA, Bond M, Butt KD, Smith CP, Shafi MS, Murphy SM. 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. [PubMed]
  • Watson PG. 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. [PubMed]
  • Monteiro EF, 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. [PubMed]
  • Priestley CJ. 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. [PubMed]
  • 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. [PubMed]
  • Clarke J, Preston AD. 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. [PubMed]
  • White C, Wardropper AG. Chlamydia in a district general hospital: an audit of treatment and contact tracing. Int J STD AIDS. 1999 Jan;10(1):57–59. [PubMed]
  • Dale AW, Horner PJ, Forster GE, Daniels D, Tomlinson D, Brook MG. 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. [PubMed]
  • Jarvis RR, 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. [PubMed]

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