title: Quality of primary care for sexually transmitted diseases in Durban, South Africa: influences of patient, nurse, organizational and socioeconomic characteristics.
abstract: Quality of sexually transmitted disease (STD) primary care in South Africa varies widely but reasons for this are poorly understood. We investigated 37 randomly sampled clinics providing STD care, with simulated patients, and staff interviews and record review. Census data provided local socioeconomic indicators. Multiple regression identified independent predictors of quality. Of 271 simulated patient visits, 79% were correctly treated and 39% were correctly managed. Women received worse care, and care tended to be poorer in mainly African and mainly coloured (mixed race) areas. African and Indian nurses were more likely to provide correct treatment. Previous STD training was marginally associated with correct treatment. Quality assessments using simulated patients were not generally associated with assessments using staff interviews and record review. There were frequent missed opportunities for STD prevention and treatment, and evidence of racial but not socioeconomic inequalities.
authors.affiliation: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. m.bachmann@uea.ac.uk
authors.forename: M O
authors.initials: MO
authors.lastname: Bachmann
authors.forename: M S E
authors.initials: MS
authors.lastname: Colvin
authors.forename: D
authors.initials: D
authors.lastname: Nsibande
authors.forename: C
authors.initials: C
authors.lastname: Connolly
authors.forename: B
authors.initials: B
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards*; D000900:Anti-Bacterial Agents / Q000600:supply & distribution / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D017280:Condoms / Q000600:supply & distribution; D016358:Contact Tracing; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008487:Medical History Taking / Q000592:standards; D010353:Patient Education as Topic / Q000592:standards; D016544:Patient Simulation; D010808:Physical Examination / Q000592:standards; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012737:Sex Factors; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000628:therapy*; D012959:Socioeconomic Factors; D013019:South Africa
chemical_list: D000900:Anti-Bacterial Agents