Department of Pediatrics, Section of Hospital Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Pediatrics, Section of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Adolesc Health. 2019 Jun;64(6):721-724. doi: 10.1016/j.jadohealth.2019.01.005. Epub 2019 Mar 14.
Adolescents are at high risk for sexually transmitted infections (STIs) and pregnancy. Since many adolescents have poor access to preventive care, hospitalizations present a critical opportunity to address adolescents' reproductive health. The purpose of this study was to assess provision of reproductive health services within a hospital setting.
Retrospective study of a consecutive sample of adolescent patients aged 13 years and older hospitalized on the hospitalist service at a large academic pediatric tertiary care center. Measures included sexual history documentation, pregnancy and STI testing, Human papillomavirus immunization status and administration, and provision of contraception.
Only 55% of 150 patients had sexual history documentation, and of those, 47% endorsed sexual activity. Associations with increased likelihood of sexual history documentation included female patients (67% vs. 36%, p < .01), hospitalizations for ingestion (71% vs. 48%, p < .01), hospitalizations to hospital medicine compared with critical care (59% vs. 14%, p < .01), and admission note written by an intern compared with a senior resident, advanced practice provider, or fellow (67% vs. 44%, 29%, 13%, p < .01). Eighteen patients (12%) were tested for STIs. Only 19% of patients due for human papillomavirus immunization received it. Sixty percent of females received a pregnancy test. Contraception was provided in two encounters (2% of females).
Results demonstrate a substantial missed opportunity to provide reproductive health services to hospitalized adolescents. Providers in hospital settings should optimize the opportunity to screen for sexual activity and reproductive health needs, provide indicated services, and offer education regarding reproductive health to hospitalized adolescents.
青少年面临较高的性传播感染（STI）和妊娠风险。由于许多青少年难以获得预防保健服务，住院治疗为解决青少年生殖健康问题提供了一个关键机会。本研究旨在评估医院环境中提供生殖健康服务的情况。
对一家大型学术儿科三级保健中心住院医师服务部门连续收治的 13 岁及以上青少年患者进行回顾性研究。评估指标包括性史记录、妊娠和 STI 检测、人乳头瘤病毒（HPV）免疫接种状况和管理以及提供避孕措施。
150 名患者中仅有 55%记录了性史，其中 47%有性行为。增加性史记录可能性的关联因素包括女性患者（67% vs. 36%，p<.01）、因摄入而住院（71% vs. 48%，p<.01）、与重症监护相比，住院于医院内科（59% vs. 14%，p<.01），以及由住院医师、高级执业医师、研究员或住院医生（67% vs. 44%、29%、13%，p<.01）记录入院记录。18 名患者（12%）接受了 STI 检测。仅 19%的应接种 HPV 疫苗的患者接受了疫苗接种。60%的女性接受了妊娠检测。在两次就诊中（2%的女性）提供了避孕措施。
结果表明，为住院青少年提供生殖健康服务存在大量机会错失。医院环境中的提供者应优化机会，对性行为和生殖健康需求进行筛查，提供必要的服务，并向住院青少年提供生殖健康教育。
