The evaluation of treatment of chlamydia and gonorrhea in the emergency department at a military treatment facility

Abstract

Background

Sexually transmitted infections (STIs) have a major impact on global sexual and reproductive health. A systematic review of 13 studies involving emergency department (ED) patients who were tested and empirically treated for Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT), or both before receiving their nucleic acid amplification test results revealed that up to 84% of patients with positive test results were ultimately undertreated. Addressing this discrepancy is crucial for enhancing the quality of care for patients.

Objective

This study aimed to evaluate the impact of pharmacist-led interventions on the incidence of guideline-concordant empirical treatment for chlamydia and gonorrhea in patients presenting to the ED at a large academic military treatment facility (MTF).

Methods

A retrospective chart review was conducted at a large academic MTF ED from June 1, 2023, to September 30, 2023. Adult patients screened and treated for CT and NG were included. The primary outcome measured the percentage of patients who received empirical guideline-concordant treatment. Secondary outcomes included the number of patients untreated in the ED, patients who returned for treatment, and those lost to follow-up. After baseline data collection, a pharmacy-led in-service was conducted with educational handouts and education regarding the creation of an STI order set. A postintervention analysis was conducted from February 13, 2024, to April 30, 2024. Data were analyzed with descriptive statistics and chi-squared tests for categorical associations and means and SD for parametric data.

Results

In the preintervention group, 108 of 304 screened patients met inclusion criteria; 64 patients (59%) received concordant empirical treatment. After the intervention, 52 of 58 included patients (90%) received guideline-concordant treatment, showing a statistically significant improvement (P < 0.001). Inappropriate treatment duration and dosage were common preintervention issues. After the intervention, adherence to guidelines improved, reducing inappropriate treatment cases.

Conclusion

A notable proportion of patients initially received inappropriate treatment. Implementing clinician education and order sets significantly improved compliance with treatment guidelines, demonstrating the effectiveness of targeted quality improvement initiatives.