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J Pediatr. 2014 Aug;165(2):343-7. doi: 10.1016/j.jpeds.2014.04.009. Epub 2014 May 17.

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

Author information

1
Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC. Electronic address: mgoyal@cnmc.org.
2
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
3
Children's Hospital of Philadelphia, Philadelphia, PA.
4
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Children's Hospital of Philadelphia, Philadelphia, PA.

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.

PMID:
24840761
PMCID:
PMC4111974
DOI:
10.1016/j.jpeds.2014.04.009
[Indexed for MEDLINE]
Free PMC Article

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