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STD prevention and treatment guidelines: a review from a managed care perspective.
Am J Managed Care 2003; 9(2):181-189; quiz 190-191.
Scholes D, Anderson LA, Operskalski BH, Bluespruce J, Irwin
K, Magid
DJ.
Abstract
OBJECTIVE: To conduct a standardized review of sexually transmitted disease
(STD) clinical practice guidelines from a managed care perspective. STUDY
DESIGN: Eight guidelines that address STD prevention and care received dual
review on selected content and formatting criteria. Content criteria included
currency of information, coverage of 7 selected STDs, attention to primary
prevention areas (risk assessment, patient education, counseling), attention
to system/implementation issues (time/costs/training) of integrating STD
practices into routine clinical care, and referencing of scientific literature.
Format/presentation criteria included ease of accessing STD information,
clear identification of STD recommendations, availability of handbook/pocket
versions, and availability of online version. Chlamydia screening and treatment
recommendations were compared for 3 guidelines. RESULTS: The 8 guidelines
addressed a variety of target populations. Two focused exclusively on STDs.
Three were current at the time of the review (1998 or later), 2 covered all
selected STDs, 3 gave considerable emphasis to primary prevention, and 4
cited relevant scientific sources. One guideline was classed as having good
coverage of system/implementation issues. Information for specific STDs was
readily located and concisely presented in 2 of the guidelines. Four sources
had handbook/pocket versions, and 5 had on-line versions. Based on these
findings, we suggest modifications for future versions of these guidelines
that may increase their usefulness to managed care settings. CONCLUSIONS:
Currently available STD guidelines potentially can be of great use to managed
care providers and decisionmakers. The relevance to managed care organizations
of a number of guidelines could be increased in several areas, particularly
by greater focus on primary prevention and by providing access to tools and
strategies to foster integration of STD services into routine clinical care.