STDs aren't sexy: health professionals' lack of adherence to clinical guidelines in an area of high STD endemicity

Background In 1997 the Health Department of Western Australia distributed clinical guidelines aimed at improving the outcomes of care of patients with STDs. In recognition of the high STD rates and issues peculiar to the Kimberley region, a Kimberley Supplement was inserted into copies distributed in the region. Since then, annual STD workshops have been conducted for all Kimberley health professionals involved in any aspect of STD management. This study aimed to assess whether health professionals were observing the Guidelines and its Kimberley Supplement, and whether adherence improved after the 1998 Kimberley STD workshop tour.Methods Over two periods, pre- and post-STD workshops, all pathology request farms for gonorrhoea and chlamydia tests were collected from all laboratories in the region. The outcomes of interest were which of the recommended tests had been requested. Logistic regression was used to analyse associations between adherence to the Guidelines and patient's age, sex and postcode, profession of practitioner, reason for testing and whether the test was performed pre- or post-STD workshops.Results Minimum appropriate tests were ordered on only 14.5 per cent (98/676) of request forms. Univariate and multivariate analyses showed that minimum appropriate testing was more likely to have been requested on male patients and if the practitioner was a doctor. No improvement was observed after the STD workshops.Conclusion The poor adherence and lack of improvement observed can be explained by Kotter's framework on why transformation efforts fail. This study demonstrates that clinical guidelines are of little value unless they are continuously evaluated.