title: Point-of-care testing improves accuracy of STI care in an emergency department.
abstract: OBJECTIVE
  We aimed to examine the impact of a point-of-care (POC) test on overtreatment and undertreatment of sexually transmitted infections (STIs) by comparing treatment patterns for gonorrhoea (detected with nucleic acid amplification testing (NAAT)) with trichomoniasis (detected by POC test) for young women seen in an emergency department (ED).
  
  
  METHODS
  We reviewed the database of a quality improvement (QI) project that aims to improve follow-up care for STIs in the ED. Data included the test result and antibiotic given (if any) during visits by women age 14-21 for whom an STI test was ordered. We generated Shewhart control charts and compared overtreatment and undertreatment rates for gonorrhoea and trichomoniasis using χ(2) testing.
  
  
  RESULTS
  Of 1877 visits over 18 months, 8.8% of women had gonorrhoea and 16.5% had trichomoniasis. Overtreatment was higher for women with gonorrhoea than trichomoniasis (54% vs 23%, p<0.001). Overtreatment for gonorrhoea decreased from 58% to 47% (p<0.01) and overtreatment for trichomoniasis decreased from 24% to 18% (p<0.01), which corresponded to improvements in patient follow-up for the QI project. Undertreatment was higher for women with gonorrhoea than trichomoniasis (29% vs 21%, p=0.03), and did not change over time.
  
  
  CONCLUSIONS
  A POC test improves the accuracy of STI care in an ED compared with NAAT testing. An unanticipated benefit of QI efforts to improve patient follow-up is the observed decrease in antibiotic use in the ED. Given the ability of gonorrhoea to develop antibiotic resistance, future efforts should focus on development of an accurate POC test for gonorrhoea.
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229–3039, USA. jennifer.reed@cchmc.org
authors.forename: Jill S
authors.initials: JS
authors.lastname: Huppert
authors.forename: Regina G
authors.initials: RG
authors.lastname: Taylor
authors.forename: Sarah
authors.initials: S
authors.lastname: St Cyr
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hesse
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Reed
mesh_terms: D000293:Adolescent; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006069:Gonorrhea / Q000175:diagnosis* / Q000188:drug therapy*; D006302:Health Services Research; D006801:Humans; D019095:Point-of-Care Systems; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000188:drug therapy*; D014245:Trichomonas Infections / Q000175:diagnosis* / Q000188:drug therapy*; D055815:Young Adult
keywords: ADOLESCENT; CLINICAL STI CARE; GONORRHOEA; TREATMENT; TRICHOMONAS