Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16: Before and after clinical audit feedback

Jane L. Goller, Christopher K. Fairley, Alysha M. De Livera, Marcus Y. Chen, Catriona S. Bradshaw, Eric P. F. Chow, Rebecca Guy, Jane S. Hocking

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: A 2006 Australian sexual health clinic audit of pelvic inflammatory disease (PID) diagnosis rates found variability between doctors. Doctors were given audit feedback towards increasing diagnosis and reducing variability. The clinic implemented other improvements to increase capacity. This study investigated PID diagnosis time trends before and after feedback. Methods: Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability. Results: During 2002-16, 144 doctors undertook 84 476 female consultations and diagnosed 1755 (2.1%, 95% confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased 0.8% (37/4836) to 2.9% (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1%-47.2%) or had a lower genital infection diagnosed (10.1%-14.9%). After feedback, PID rates increased by 8% yearly (incidence rate ratio (IRR) 1.08, 95% CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95% CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback. Conclusions: Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements.

Original languageEnglish
Article numberSH18119
Pages (from-to)247-253
Number of pages7
JournalSexual Health
Volume16
Issue number3
DOIs
Publication statusPublished - Apr 2019

Keywords

  • diagnostic criteria
  • service improvements
  • sexually transmissible infections

Cite this

@article{3dc85eaaefe240bc98365023fd06bcf3,
title = "Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16: Before and after clinical audit feedback",
abstract = "Background: A 2006 Australian sexual health clinic audit of pelvic inflammatory disease (PID) diagnosis rates found variability between doctors. Doctors were given audit feedback towards increasing diagnosis and reducing variability. The clinic implemented other improvements to increase capacity. This study investigated PID diagnosis time trends before and after feedback. Methods: Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability. Results: During 2002-16, 144 doctors undertook 84 476 female consultations and diagnosed 1755 (2.1{\%}, 95{\%} confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased 0.8{\%} (37/4836) to 2.9{\%} (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1{\%}-47.2{\%}) or had a lower genital infection diagnosed (10.1{\%}-14.9{\%}). After feedback, PID rates increased by 8{\%} yearly (incidence rate ratio (IRR) 1.08, 95{\%} CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95{\%} CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback. Conclusions: Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements.",
keywords = "diagnostic criteria, service improvements, sexually transmissible infections",
author = "Goller, {Jane L.} and Fairley, {Christopher K.} and {De Livera}, {Alysha M.} and Chen, {Marcus Y.} and Bradshaw, {Catriona S.} and Chow, {Eric P. F.} and Rebecca Guy and Hocking, {Jane S.}",
year = "2019",
month = "4",
doi = "10.1071/SH18119",
language = "English",
volume = "16",
pages = "247--253",
journal = "Sexual Health",
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Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16 : Before and after clinical audit feedback. / Goller, Jane L.; Fairley, Christopher K.; De Livera, Alysha M.; Chen, Marcus Y.; Bradshaw, Catriona S.; Chow, Eric P. F.; Guy, Rebecca; Hocking, Jane S.

In: Sexual Health, Vol. 16, No. 3, SH18119, 04.2019, p. 247-253.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Trends in diagnosis of pelvic inflammatory disease in an Australian sexual health clinic, 2002-16

T2 - Before and after clinical audit feedback

AU - Goller, Jane L.

AU - Fairley, Christopher K.

AU - De Livera, Alysha M.

AU - Chen, Marcus Y.

AU - Bradshaw, Catriona S.

AU - Chow, Eric P. F.

AU - Guy, Rebecca

AU - Hocking, Jane S.

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Y1 - 2019/4

N2 - Background: A 2006 Australian sexual health clinic audit of pelvic inflammatory disease (PID) diagnosis rates found variability between doctors. Doctors were given audit feedback towards increasing diagnosis and reducing variability. The clinic implemented other improvements to increase capacity. This study investigated PID diagnosis time trends before and after feedback. Methods: Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability. Results: During 2002-16, 144 doctors undertook 84 476 female consultations and diagnosed 1755 (2.1%, 95% confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased 0.8% (37/4836) to 2.9% (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1%-47.2%) or had a lower genital infection diagnosed (10.1%-14.9%). After feedback, PID rates increased by 8% yearly (incidence rate ratio (IRR) 1.08, 95% CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95% CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback. Conclusions: Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements.

AB - Background: A 2006 Australian sexual health clinic audit of pelvic inflammatory disease (PID) diagnosis rates found variability between doctors. Doctors were given audit feedback towards increasing diagnosis and reducing variability. The clinic implemented other improvements to increase capacity. This study investigated PID diagnosis time trends before and after feedback. Methods: Yearly PID diagnosis rates for women aged 16-49 years attending the clinic (2002-16) were calculated. Using multivariable generalised linear mixed models, adjusted for patient risk and lower genital infection (any of chlamydia, gonorrhoea, Mycoplasma genitalium, bacterial vaginosis) and stratified by before (2002-June 2007) and after (July 2007-2016) feedback, we assessed if PID rates changed over time, accounting for between-doctor variability. Results: During 2002-16, 144 doctors undertook 84 476 female consultations and diagnosed 1755 (2.1%, 95% confidence interval (CI) 2.0-2.2) with PID. Comparing 2002-03 to 2015-16, the yearly PID rate increased 0.8% (37/4836) to 2.9% (209/7088). Comparing before and after feedback more women reported any symptoms at triage (35.1%-47.2%) or had a lower genital infection diagnosed (10.1%-14.9%). After feedback, PID rates increased by 8% yearly (incidence rate ratio (IRR) 1.08, 95% CI 1.06-1.11), but were unchanged (adjusted IRR (aIRR) 1.01, 95% CI 0.98-1.03) after adjustment for patient characteristics. Factors associated with PID were self-reported symptoms, younger age and a lower genital infection. Lower variability in doctor-specific rates was observed after feedback. Conclusions: Increasing PID diagnosis rates appeared to be driven by a greater female patient risk profile, influenced by increased capacity following service improvements.

KW - diagnostic criteria

KW - service improvements

KW - sexually transmissible infections

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U2 - 10.1071/SH18119

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