Clinic Staff Adherence to the CDC’s STD Treatment Guidelines: A QI Initiative in a Local Health Department

Abstract

The Orange County Health Department (OCHD), a medium sized health department in central North Carolina, manages many patients for sexually transmitted diseases (STDs) based on the CDC’s STD Treatment Guidelines and guidance from state public health experts. To ensure program compliance, chart audits are performed by external agencies to help secure program funding. Although this exercise is useful to obtain baseline data, it does little to ensure clinic staff adherence to the CDC’s guidelines for the treatment of chlamydia, gonorrhea, and syphilis. The purpose of this project was to examine the level of adherence by OCHD clinic staff to the CDC’s 2010 STD Treatment Guidelines. A retrospective chart audit was performed to assess STD treatment and follow-up of clients who presented to the OCHD and tested positive for chlamydia, gonorrhea, or syphilis July 1, 2014- July 1, 2015. Additional client and staff information was collected to assess factors that either promoted or prohibited adherence. Similar to findings in the literature, high levels of treatment adherence were noted, but rescreening rates were suboptimal. No patient or staff factors were significantly associated with these low levels. Despite this, measures such as succinct and consistent client and staff education, greater use of technology, ongoing quality improvement activities, and proactive public policies are needed to ensure health departments meet the complex and growing needs of individuals and communities.