Assessment of vulvovaginal complaints: agreement between phone and office management

Objective: To examine the agreement between nursing phone and provider office management of vulvovaginitis.Methods: Patients who called the Kaiser Permanente Phone Call Center with vulvovaginal complaints were evaluated by a registered nurse, who took a standardized history, and made an assessment and plan; additionally, she made a judgment regarding whether she would have treated the patient over the phone. These patients were seen in the office the same day and examined and treated by a clinician following a protocol that included cultures for typical vaginal and cervical pathogens. Providers also made a judgment about phone treatment. Nurses and providers were blinded to each others' diagnosis and therapy. Kappa coefficients were used to evaluate the interexaminer agreement between nurses on the phone and providers in the office with respect to diagnosis and treatment.Results: Four hundred eighty-five patients underwent phone evaluation. Of these, 253 (52%) completed the study protocol and were considered in the final analysis. Kappa values for the diagnosis of trichomoniasis (0.05), bacterial vaginosis (0.12), candidiasis (0.22), chlamydia, herpes simplex, and urinary tract infections (0.05), and "other" (0.05) demonstrated poor agreement between nurses and providers. There was also poor agreement between phone nurses and providers regarding the necessity of an office visit (0.14).Conclusion: This prospective study challenges the notion that the telephone is an effective tool for diagnosing and treating vulvovaginal complaints. Patients with these complaints should be evaluated in the office. Alternatively, programs should be developed and analyzed to educate nurses involved in telephone triage of vulvovaginitis.