Objectives: To assess the quality of sexually transmitted disease (STD) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommendations for improving the quality of care and promote the syndromic approach to STD treatment.
Methods: Structured observations of consultations for STDs in health care facilities. Scoring of the observations according to standards for history taking, examination, treatment and provision of basic health promotion advice allows evaluation of STD case management.
Results: With STD treatment adequacy scored against Indian national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndrome approach towards selected STD (male urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactory managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms in order to prevent STD or HIV/AIDS was given. Instructions regarding how to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterion of adequate use of the STD consultation for health promotion, requiring both promotion of condoms and encouragement to refer partner(s) for treatment, was met during 13 (12%) of consultations.
Conclusions: Monitoring and improving the standards of care at facilities at which STDs are treated have become key roles of STD/HIV/AIDS programmes. The present report suggests that in Madras the activities of medical practitioners who treat STD patients are far from ideal at present. Improvements would involve simplifying existing treatment guidelines by promoting the syndromic approach to STD management, continuing education programmes for health care providers in the public and private sectors and repeat assessments and feedback of the quality of STD care.
PIP: To assess the quality of sexually transmitted disease (STD) case management in Madras, Tamil Nadu State, India, structured observations of 108 consultations with 48 doctors at 65 private and public health facilities were conducted. These observations were scored according to standards for history taking, examination, treatment, and provision of basic health promotion counseling. When scored against national guidelines (which outline an etiologic approach to diagnosis), history taking, examination, and treatment were judged adequate in 76 observations (70%). However, if STD treatment adequacy was rated according to a syndromic approach (recommended by the World Health Organization) to selected STDs (male urethritis and nonherpetic male and female genital ulcers), only 8 (10%) of 81 such patients were managed satisfactorily. Condom use to prevent further STDs was encouraged in 32 consultations (30%), but instructions on how to use condoms properly was offered to only 7 patients (6%) and condoms were provided to just 1 patient (1%). Use of the STD consultation for health promotion, defined as condom promotion and encouragement to refer sexual partners for treatment, was adequate in 13 consultations (12%). These findings suggest a need for improvements in the standards of STD care at health facilities in Madras. Recommended are measures such as simplification of existing national guidelines for the treatment and prevention of STDs, promotion of a syndromic approach to STD management, continuing education programs for providers, and repeat assessments and feedback on the quality of STD care.