The Management of Gonococcal Infections and the Development and Use of Treatment Guidelines

• Main Author: Dickson, Catherine
• Other Authors: Grimshaw, Jeremy
• Language: en
• Published: Université d'Ottawa / University of Ottawa 2016
• Subjects: Gonorrhea; STI; Clinical guidelines; Antibiotic use
• Online Access: http://hdl.handle.net/10393/34862; http://dx.doi.org/10.20381/ruor-6068

N. Gonorrhoeae is a major public health concern due to its capacity to develop antibiotic resistance and its potential complications including pelvic inflammatory disease, epididymitis, infertility, and disseminated infection. In order to keep up with resistance trends, the treatment recommendations for gonorrhea have changed frequently. In other areas of medicine, guideline adherence has been shown to be limited, even without frequent guideline changes. In the case of gonorrhea, inappropriate treatment can have serious individual and public health implications, making the quality of and compliance with clinical guidelines critical. This thesis is a three-part mixed methods research project assessing the development and uptake of gonorrhea treatment guidelines. We conducted a systematic review of current gonorrhea treatment guidelines and used the AGREE II tool to assess the quality of guideline development (Chapter 2). We observed that guideline quality varied greatly with many guidelines having weaknesses in their use of existing evidence to develop recommendations, their reporting of potential conflicts of interest and how they were addressed, and their consideration of barriers to the implementation of their recommendations. We then assessed physician adherence to first-line treatment recommendations in Ontario by conducting a segmented time series analysis of Ontario gonorrhea treatment data from iPHIS, the province’s reportable disease database (Chapter 3). Following the introduction of new guidelines that recommended substantial changes from current practice, we found very dramatic drops in guidelines adherence that then improved slowly over time. We then explored the use of process mapping as a tool to look at the local management of cases in the City of Ottawa by following them across the various possible treatment pathways (Chapter 4). Here, we noted differences in practice between the management of cases at Ottawa Public Health’s Sexual Health Clinic and the management of cases elsewhere in the community.