Background Massachusetts experienced a 29% increase in gonorrhoea cases during 2010. In 4% of cases where treatment was known, treatment was inconsistent with public health guidelines. We examined healthcare provider characteristics associated with gonorrhoea treatment errors to help target future educational outreach strategies.
Methods Case-control study where treatment error cases were defined as any patient 15–65 years of age, diagnosed with gonorrhoea in 2010, who did not receive ceftriaxone 125 mg or 250 mg IM or other approved cephalosporin regimen, or azithromycin 2 g PO. Two controls were randomly selected from patients who received correct treatment, matched to cases in regard to age, sex, and month of diagnosis. Data regarding exposures to various provider characteristics were collected from case report cards, provider licensing databases, and direct provider phone calls. Proportions of cases and controls were compared on the basis of provider training, years in practice, specialty, and practice type by χ2 analysis or Fisher's exact test.
Results 76 cases were matched to 152 controls. In preliminary analysis, no differences were identified with respect to provider degree (MD/DO or NP/PA; p>0.25). More treatment errors occurred in private practice/health maintenance organisations compared to STD or family planning clinics (p<0.0001), emergency departments (p<0.0001), or community health centers/hospital clinics (p=0.0004). Among physicians, no differences were identified with respect to years since residency graduation (p>0.25). More treatment errors occurred with family medicine physicians compared to OB/GYN (p=0.0225) and emergency medicine physicians (p=0.0101), but not compared to paediatricians or internists see Abstract P5-S6.34 table 1.
Conclusions Although gonorrhoea treatment errors were rare, specific practice locations and physician specialties were significantly associated with gonorrhoea treatment errors, suggesting important opportunities for educational intervention. Further studies may determine reasons for errors, relative importance of provider factors, and what systems support accurate treatment.