Masonbrink Abbey R, Stancil Stephani, Reid Kimberly J, Goggin Kathy, Hunt Jane Alyce, Mermelstein Sarah J, Shafii Taraneh, Lehmann Amber G, Harhara Haleema, Miller Melissa K
Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.
Hosp Pediatr. 2019 Feb;9(2):100-106. doi: 10.1542/hpeds.2018-0051. Epub 2019 Jan 8.
Many hospitalized adolescents are at increased risk for pregnancy complications due to an underlying medical condition, however sexual risk assessment is not consistently performed in this setting. While adolescents and their parents are supportive of sexual health discussion in the inpatient setting, a thorough understanding of factors that influence provision of this care among pediatric hospital physicians is lacking. This formative information is needed to facilitate efforts to improve and standardize clinical care provision. Our objective is to assess the frequency and factors that influence the provision of adolescent sexual and reproductive care by pediatric hospitalists.
We performed a cross-sectional computerized survey of hospitalists at 5 pediatric hospitals who cared for ≥1 adolescent (14-21 years old) in the past year. Sexual and reproductive care practices were assessed by using a 76-item novel survey informed by the theory of planned behavior. We used descriptive statistics to summarize the data.
Sixty-eight pediatric hospitalists participated (49% response rate): 78% were women and 65% were aged <40 years. Most (69%) reported treating >46 adolescents annually, including many who are at an increased risk for pregnancy complications due to teratogenic medication use or a comorbid condition. A majority felt that sexual and reproductive services are appropriate, although many endorsed barriers, including concern about follow-up after emergency contraception (63%) and time constraints (53%). Most reported insufficient knowledge regarding contraception (59%), desired contraception education (57%), and were likely to increase contraceptive provision if provided education (63%). Hospitalists rarely provided condoms or referral for an intrauterine device.
Pediatric hospitalists frequently care for adolescents who are at risk for pregnancy complications and generally agree that reproductive care is appropriate in the inpatient setting. With these findings, we highlight the critical need for effective comprehensive reproductive health service interventions that are tailored to address the numerous actionable barriers identified in this study.
许多住院青少年因潜在的医疗状况而面临妊娠并发症风险增加的问题，然而在这种情况下，性风险评估并未始终得到开展。虽然青少年及其父母支持在住院环境中进行性健康讨论，但对于影响儿科医院医生提供此类护理的因素缺乏全面了解。需要这些形成性信息来促进改善和规范临床护理提供的努力。我们的目的是评估儿科住院医生提供青少年性与生殖护理的频率及影响因素。
我们对5家儿科医院中过去一年里照顾过≥1名青少年（14 - 21岁）的住院医生进行了横断面计算机化调查。使用基于计划行为理论设计的76项新调查问卷评估性与生殖护理实践。我们用描述性统计方法总结数据。
68名儿科住院医生参与调查（回复率49%）：78%为女性，65%年龄小于40岁。大多数（69%）报告每年治疗超过46名青少年，其中许多人因使用致畸药物或合并症而面临妊娠并发症风险增加。大多数人认为性与生殖服务是合适的，尽管许多人认可存在障碍，包括对紧急避孕后随访的担忧（63%）和时间限制（53%）。大多数人报告避孕知识不足（59%），希望接受避孕教育（57%），并且如果接受教育，很可能增加避孕措施的提供（63%）。住院医生很少提供避孕套或转诊放置宫内节育器。
儿科住院医生经常照顾有妊娠并发症风险的青少年，并且总体上同意在住院环境中提供生殖护理是合适的。基于这些发现，我们强调迫切需要有效的全面生殖健康服务干预措施，以解决本研究中确定的众多可采取行动的障碍。
