Assessment of vulvovaginal complaints: accuracy of telephone triage and in-office diagnosis.
OBJECTIVE
To examine the agreement between telephone and office management of vulvovaginal complaints and to assess the accuracy of diagnosis of vulvovaginitis.


METHODS
Prospective structured telephone nurse interviews of all patients with vulvovaginal complaints who called the Kaiser Permanente Telephone Call Center were conducted. Patients were appointed to a physician, nurse midwife, or physician's assistant for office evaluation. Both groups (nurses and practitioners) made independent diagnosis and treatment decisions. kappa coefficients were used to evaluate the interexaminer agreement between telephone nurses and practitioners, and practitioners and traditional diagnostic tests.


RESULTS
A total of 485 patients underwent telephone interviews, and 253 (52%) completed the study protocol. kappa values showed poor agreement between nurses and practitioners for bacterial vaginosis (0.12), candidiasis (0.22), and trichomoniasis (-0.05). Practitioners failed to accurately diagnose vaginitis when kappa values were analyzed. There was also poor agreement between telephone nurses and practitioners regarding the necessity of an office visit (0.14).


CONCLUSIONS
This prospective study challenges the notion that the telephone is an effective tool to diagnose and treat vulvovaginal complaints. Moreover, given the poor agreement between practitioners' diagnoses and microbiologic and microscopic data, further study into optimal diagnosis of vulvovaginitis is needed.
Allen-Davis
Jandel T
JT
Department of Obstetrics and Gynecology, Kaiser Permanente, Wheat Ridge, Colorado 80003, USA. c.allen-davis@kp.org
Beck
Arne
A
Parker
Ruth
R
Ellis
Jennifer L
JL
Polley
Dana
D
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D005260:Female; D006279:Health Maintenance Organizations / Q000592:standards; D006801:Humans; D008875:Middle Aged; D008880:Midwifery / Q000592:standards; D009819:Office Visits; D010823:Physician Assistants / Q000592:standards; D011336:Probability; D011446:Prospective Studies; D019114:Remote Consultation / Q000592:standards*; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D013689:Telephone; D014218:Triage / Q000592:standards*; D014247:Trichomonas Vaginitis / Q000175:diagnosis* / Q000628:therapy; D014481:United States; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000628:therapy; D014848:Vulvovaginitis / Q000175:diagnosis* / Q000628:therapy