Clinician adherence to recommendations for screening of adolescents for sexual activity and sexually transmitted infection/human immunodeficiency virus.

TitleClinician adherence to recommendations for screening of adolescents for sexual activity and sexually transmitted infection/human immunodeficiency virus.
Publication TypeJournal Article
Year of Publication2014
AuthorsGoyal MK, Witt R, Hayes KL, Zaoutis TE, Gerber JS
JournalJ Pediatr
Volume165
Issue2
Pagination343-7
Date Published2014 Aug
ISSN1097-6833
KeywordsAdolescent, Cross-Sectional Studies, Female, Guideline Adherence, HIV Infections, Humans, Logistic Models, Male, Mass Screening, Practice Guidelines as Topic, Primary Health Care, Retrospective Studies, Sexual Behavior, Sexually Transmitted Diseases, Young Adult
Abstract

OBJECTIVES: To evaluate clinician adherence to guidelines for documentation of sexual history and screening for sexually transmitted infection (STI)/HIV infection during routine adolescent well visits. Secondary objectives were to determine patient and clinician factors associated with sexual history documentation and STI/HIV testing.

STUDY DESIGN: Retrospective, cross-sectional study of 1000 randomly selected 13- to 19-year-old routine well visits at all 29 pediatric primary care practices affiliated with a children's hospital. We evaluated frequency of documentation of sexual history and testing for gonorrhea (GC)/chlamydia (CT) and HIV testing. Multivariable logistic regression was performed to identify factors associated with documentation and testing.

RESULTS: Of the 1000 patient visits reviewed, 212 (21.2%; 95% CI, 18.7-23.7) had a documented sexual history, of which 45 adolescents' (21.2%; 95% CI, 15.7-26.8) encounters were documented as being sexually active. Overall, 26 (2.6%; 95% CI, 1.6-3.6) patients were tested for GC/CT and 16 (1.6%; 95% CI, 0.8-2.4) were tested for HIV infection. In multivariable analyses, factors associated with sexual history documentation included older patient age, non-Hispanic black race/ethnicity, nonprivate insurance status, and care by female clinician. Factors associated with GC/CT testing included male gender, non-Hispanic black race/ethnicity, and nonprivate insurance. HIV testing was more likely to be performed on older adolescents, those of non-Hispanic black race/ethnicity, and those with nonprivate insurance.

CONCLUSIONS: Pediatric primary care clinicians infrequently document sexual histories and perform STI and HIV testing on adolescent patients. Future studies should investigate provider beliefs, clinical decision-making principles, and perceived barriers to improve the sexual health care of adolescents and evaluate interventions to increase rates of adolescent sexual health screening.

DOI10.1016/j.jpeds.2014.04.009
Alternate JournalJ. Pediatr.
PubMed ID24840761
PubMed Central IDPMC4111974
Grant ListK23 HD070910 / HD / NICHD NIH HHS / United States
K23 HD070910 / HD / NICHD NIH HHS / United States