Lehigh Valley Health NetworkLVHN Scholarly Works

USF-LVHN SELECT

Gender Differences in CDC GuidelineCompliance for STIs in Emergency Departments.Bryan G. Kane MDLehigh Valley Health Network, bryan.kane@lvhn.org

Alexander W D GuillaumeUSF- LVHN SELECT Program, alexander.guillaume@lvhn.org

Elizabeth M. Evans DOLehigh Valley Health Network, Elizabeth.Evans@lvhn.org

Terrence E. Goyke DOLehigh Valley Health Network, Terrence_E.Goyke@lvhn.org

Jessica K. Eygnor DOLehigh Valley Health Network, Jessica_K.Eygnor@lvhn.org

See next page for additional authors

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Published In/Presented AtKane, B. G., Guillaume, A. W.D., Evans, E. M., Goyke, T. E., Eygnor, J. K., Semler, L. Duza, S. W., Greenberg, M. R. (2017, March).Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments. Poster Presented at: 2017 SELECT CapstonePosters and Presentations Day. Kasych Family Pavilon, Lehigh Valley Health Network, Allentown, PA.

AuthorsBryan G. Kane MD; Alexander W D Guillaume; Elizabeth M. Evans DO; Terrence E. Goyke DO; Jessica K.Eygnor DO; Lauren Semler MS; Stephen W. Dusza DrPH; and Marna R. Greenberg DO, MPH, FACEP

This poster is available at LVHN Scholarly Works: https://scholarlyworks.lvhn.org/select-program/139

Introduction

© 2017 Lehigh Valley Health Network

Problem Statement

Results

Conclusions and Future Implications

References:1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2014. Atlanta: U.S. Department of Health and Human Services; 2015.

2. Schechter-Perkins EM, Dareema J, White LF, et al. Treatment of Cases of Neisseria gonorrhoeae and Chlamydia trachomatis in Emergency Department Patients. Sex Transm Dis. 2015;42(7):353-7.

3. Borhart J and Birnbaumer DM. Emergency Department Management of Sexually Transmitted Infections. Emerg Med Clin North Am. 2011;29(3):587-603.

4. Consideration of Sex as a Biological Variable in NIH-funded Research. National Institute of Health Website. http://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-102.html. Published June 9, 2015. Accessed June 25, 2016.

5. Safdar B, McGregor AJ, McKee SA, et al. Inclusion of Gender in Emergency Medicine Research. Acad Emerg Med. 2011;18(2):e1-4.

6. Safdar B and Greenberg MR. Applying the Gender Lens to Emergency Care: From Bench to Bedside. Acad Emerg Med. 2014;21(12):1325-8.

7. Evans EM, Goyke TE, Cohrac SA, et al. Compliance with centers for disease control guidelines for ED patients with sexually transmitted diseases. Am J Emerg Med. 2016.pii:S0735-6757(16)30268-6. [Epub ahead of print].

• According to the CDC, the rate of sexually transmitted infections (STIs) is rising.1

• STIs are a common reason for Emergency Department (ED) visits.2

• Women who develop an STI of the upper genital tract are at increased risk for long-term sequelae including infertility and ectopic pregnancy.3

• The need to recognize and adjust for sex and gender differences is a growing topic in medical research.4

• One recent review found that only 18% of Emergency Medicine (EM)-related studies examined health outcome by gender, and that only 2% of studies included gender in the primary hypothesis.5

• Because EDs experience 136 million patient visits annually, EM providers have the opportunity to be a leading source of gender-based research.6

• 247 participants were included, 159 (64.4%) were female.• All 88 males presented with urethritis; 25.8% of females presented with cervicitis, and 74.2% with PID. • Physician compliance for the five CDC criteria ranged from 68.8% for patient history to 93.5% for patient

diagnostic testing.• 54.1% of female charts had histories consistent with CDC criteria compared to 95.5% for male charts,

OR=16.9; 95% CI: 5.9-48.4 , p<0.001. • 51.6% of female charts had fully-documented delivery of discharge instructions compared to 97.7% of

male charts OR=42.3; 95% CI: 10.0-178.6 p<0.001).• No significant sex differences in documentation were observed for physical exam or treatment.

• This study found patient gender differences in documentation compliance with CDC guidelines for the diagnosis and treatment of STIs.

• By publishing these findings, we aim to raise awareness of gender differences so that providers are ensuring values-based, patient-centered care for their patients.

• This project also explores the SELECT competency of health systems by highlighting and analyzing other published gender differences, both in the U.S. and internationally.

• Further studies are required to determine the causes of these differences and how to alleviate them.

• The objective of this project was to identify patient gender differences in physician com-pliance with 2010 CDC recommendations for the diagnosis and treatment of STIs in the ED.

Methodology

• A retrospective chart review identified patients treated for STIs in the EDs of three LVHN hospitals during a calendar year.

• Cases were reviewed to assess for compliance with 2010 CDC guidelines across 5 domains: history, physical exam, diagnostic testing, treatment, and discharge instructions.

• Abstractors were trained by the study principle investigator using explicit protocols of inclusion and exclusion.

• Descriptive statistics, student t-tests, chi-square tests, and logistic regression were used in the analysis.

• Statistical significance was set at p ≤0.05.

• Note: this was a secondary analysis of a prior study.7

Table 1. The Distribution of Documentation Compliance with CDC 2010 Guidelines for Treatment of Sexually Transmitted Infections by Patient Sex.

Compliance Criteria Categories Coding Female Male Total OR (95% CI)* P-value

HistoryNo (ref) 73 (45.9%) 4 (4.6%) 77 (31.2%) -- --

Yes 86 (54.1%) 84 (95.5%) 170 (68.8%) 16.9 (5.9-48.4) <0.001

Physical ExaminationNo (ref) 49 (30.8%) 20 (22.7%) 69 (27.9%) -- --

Yes 110 (69.2%) 68 (77.3%) 178 (72.1%) 1.5 (0.8-2.7) 0.222

DiagnosticsNo (ref) 5 (3.2%) 11 (12.5%) 16 (6.5%) -- --

Yes 153 (96.8%) 77 (87.5%) 230 (93.5%) 0.2 (0.1- 0.7) 0.011

TherapeuticNo (ref) 12 (7.6%) 8 (9.1%) 20 (8.1%) -- --

Yes 147 (92.5%) 80 (90.9%) 227 (91.9%) 0.8 (0.3-2.0) 0.592

Discharge InstructionsNo (ref) 77 (48.4%) 2 (2.3%) 79 (32.0%) -- --

Yes 82 (51.6%) 86 (97.7%) 168 (68.0%) 42.3 (10.0-178.6) <0.001

Lehigh Valley Health Network, Allentown, PA

Gender Differences in CDC Guideline Compliance for STIs in Emergency Departments

Bryan G. Kane MD, Alexander W.D. Guillaume, Elizabeth M. Evans DO, Terrence E. Goyke DO, Jessica K. Eygnor DO, Lauren Semler MS, Stephen W. Duza DrPH; Marna Rayl Greenberg DO, MPH

* All odds ratio estimates were adjusted by participant age. In the models, females were coded as zero and males coded as 1. The odds ratios are to be interpreted as the odds of charting compliance for male relative to female patients.