Changes in the diagnosis and management of bacterial vaginosis following clinical research

Abstract

Background: It has become common practice to offer patients attending public sexual health clinics participation in research studies. We investigated the premise that clinician involvement in research leads to improvements in clinical practice within a sexual health service in Melbourne, Australia. Methods: Retrospective case note reviews were conducted of 100 cases of bacterial vaginosis (BV) during three time periods; 2000, 2002 and 2004. The first and second reviews were conducted 2 years before and immediately prior to a cross-sectional study of BV at Melbourne Sexual Health Centre. The third review was conducted immediately after study completion. Diagnostic criteria and treatment for BV were recorded. Clinicians were divided into high and low recruiters, according to the percentage of eligible patients that they recruited into the cross-sectional study. No audited cases were enrolled in the study. Results: Significant improvements in the use of Amsel’s criteria occurred between the second and third audit periods (51 to 65%, P = 0.04) but not between the first and second audits (51% for both, P = 1.0). The improvement was seen in high-recruiting clinicians (P = 0.02) but not low-recruiting clinicians (P = 0.75). Although treatment with 7 days of metronidazole or vaginal clindamycin increased for all clinicians between the first and second audit periods (8 to 18%, P = 0.04), it was greater between the second and third audit periods (18 to 72%, P < 0.01). No difference was observed between high- and low-recruiting clinicians. Conclusion: Introduction of research was temporally associated with improved clinical practice in high-recruiting clinicians only.