National assessment of PID diagnosis, treatment and management in general practice: England and Wales

A questionnaire based audit was used to evaluate the diagnosis and manageme nt of suspected pelvic inflammatory disease (PID) cases by general practiti oners (GPs) in England and Wales. Responses were compared against a clinica l management 'gold standard' devised by an independent group of GPs and spe cialists. Two hundred and ninety-seven (38%) of the 781 questionnaires were returned. Only 21 (7%) had all 'gold standard' sections correct. Diagnosti c quality was significantly higher when the clinician was female compared w ith male (odds ratio [OR]=2.34; 95% confidence limits [CL]=1.19-4.63) and d iagnostic quality increased with increasing socioeconomic deprivation. This is the first evaluation of the diagnosis and management of PID by GPs in E ngland and Wales. The unusually poor response rate to a Medical Research Co uncil General Practice Research Framework (MRC GPRF) study may reflect low disease awareness and sub-optimal management. This represents a fundamental obstacle to effective intervention and surveillance. Effective interventio n will only be possible if diagnostic practice and management are improved substantially.