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Assessment of Vulvovaginal Complaints: Accuracy of Telephone Triage and In-Office Diagnosis

From the Department of Obstetrics and Gynecology, and Clinical Research Unit, Kaiser Permanente, Wheat Ridge, Colorado.

Address reprint requests to: Jandel T. Allen-Davis, MD, Department of Obstetrics and Gynecology, Kaiser Permanente, 4803 Ward Road, Wheat Ridge, CO 80033; E-mail: jandel.c.allen-davis{at}kp.org.

OBJECTIVE: To examine the agreement between telephone and office management of vulvovaginal complaints and to assess the accuracy of diagnosis of vulvovaginitis.

METHODS: Prospective structured telephone nurse interviews of all patients with vulvovaginal complaints who called the Kaiser Permanente Telephone Call Center were conducted. Patients were appointed to a physician, nurse midwife, or physician’s assistant for office evaluation. Both groups (nurses and practitioners) made independent diagnosis and treatment decisions. coefficients were used to evaluate the interexaminer agreement between telephone nurses and practitioners, and practitioners and traditional diagnostic tests.

RESULTS: A total of 485 patients underwent telephone interviews, and 253 (52%) completed the study protocol. values showed poor agreement between nurses and practitioners for bacterial vaginosis (0.12), candidiasis (0.22), and trichomoniasis (-0.05). Practitioners failed to accurately diagnose vaginitis when values were analyzed. There was also poor agreement between telephone nurses and practitioners regarding the necessity of an office visit (0.14).

CONCLUSION: This prospective study challenges the notion that the telephone is an effective tool to diagnose and treat vulvovaginal complaints. Moreover, given the poor agreement between practitioners’ diagnoses and microbiologic and microscopic data, further study into optimal diagnosis of vulvovaginitis is needed.

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