STD prevention and treatment guidelines: a review from a managed care perspective

To conduct a standardized review of sexually transmitted disease (STD) clinical practice guidelines from a managed care perspective.

Eight guidelines that address STD prevention and care received dual review on selected content and formatting criteria. Content criteria included currency of information, coverage of 7 selected STDs, attention to primary prevention areas (risk assessment, patient education, counseling), attention to system/implementation issues (time/costs/training) of integrating STD practices into routine clinical care, and referencing of scientific literature. Format/presentation criteria included ease of accessing STD information, clear identification of STD recommendations, availability of handbook/pocket versions, and availability of online version. Chlamydia screening and treatment recommendations were compared for 3 guidelines.

The 8 guidelines addressed a variety of target populations. Two focused exclusively on STDs. Three were current at the time of the review (1998 or later), 2 covered all selected STDs, 3 gave considerable emphasis to primary prevention, and 4 cited relevant scientific sources. One guideline was classed as having good coverage of system/implementation issues. Information for specific STDs was readily located and concisely presented in 2 of the guidelines. Four sources had handbook/pocket versions, and 5 had on-line versions. Based on these findings, we suggest modifications for future versions of these guidelines that may increase their usefulness to managed care settings.

Currently available STD guidelines potentially can be of great use to managed care providers and decisionmakers. The relevance to managed care organizations of a number of guidelines could be increased in several areas, particularly by greater focus on primary prevention and by providing access to tools and strategies to foster integration of STD services into routine clinical care.