From the Department of Pediatrics.
Office of Health Information and Data Science.
Sex Transm Dis. 2022 Sep 1;49(9):610-615. doi: 10.1097/OLQ.0000000000001656. Epub 2022 Jun 2.
Adolescents bear a disproportionate burden of sexually transmitted infections (STIs) and the sequelae of delayed treatment, yet STI screening is infrequently performed in pediatric primary care clinics with many of those at-risk not administered testing. This study aims to understand contextual factors influencing STI screening and testing among adolescents in pediatric primary care.
We used the Consolidated Framework for Implementation Research (CFIR) as part of a stepwise approach to facilitate a deep understanding the pediatric primary care environment. We conducted semistructured interviews of physicians, nurses, and patient-parent dyads from 4 pediatric primary care practices in the St. Louis metropolitan area about STI screening practices and common concerns regarding STI screening. Qualitative analysis was conducted using a categorical coding technique informed by the CFIR followed by a thematic coding technique.
We interviewed 23 physicians/nurses and 12 patient-parent dyads. Individual-level barriers to STI screening and testing included wide variability in clinicians' practice patterns and their perception of STI risk in the patient population. Structural barriers included a lack of capacity to perform testing in clinic and time constraints during patient visits. Confidentiality issues also created significant barriers to screening and testing on both individual and structural levels. Adopting confidential methods for testing and educating providers on patients' recommendations for STI testing were discussed as ways to potentially improve STI care in pediatric patients.
Our use of the CFIR facilitated a systematic approach to identify gaps in STI care for adolescents and identified opportunities to close those gaps. An integrated, systematic approach that enhances patient confidentiality and improves clinicians' knowledge could address gaps in STI care in pediatric primary care settings.
青少年在性传播感染（STI）及其延迟治疗的后果方面负担过重，但在儿科初级保健诊所中，STI 筛查的频率很低，许多高危人群未接受检测。本研究旨在了解影响儿科初级保健中青少年 STI 筛查和检测的背景因素。
我们使用整合实施研究框架（CFIR）作为逐步方法的一部分，以深入了解儿科初级保健环境。我们对圣路易斯大都市区 4 家儿科初级保健诊所的医生、护士和患者-家长二人组进行了半结构化访谈，了解 STI 筛查实践情况以及 STI 筛查常见问题。使用基于 CFIR 的分类编码技术进行定性分析，然后使用主题编码技术。
我们采访了 23 名医生/护士和 12 对患者-家长。STI 筛查和检测的个体障碍包括临床医生的实践模式存在很大差异，以及他们对患者人群中 STI 风险的看法。结构障碍包括在诊所进行检测的能力不足和患者就诊期间的时间限制。保密性问题也在个体和结构层面上对筛查和检测造成了重大障碍。采用保密的检测方法，并对提供者进行有关患者 STI 检测建议的教育，被认为是改善儿科患者 STI 护理的潜在方法。
我们使用 CFIR 促进了一种系统的方法，以确定青少年 STI 护理中的差距，并确定了缩小这些差距的机会。一种增强患者保密性和提高临床医生知识的综合、系统方法可以解决儿科初级保健环境中 STI 护理的差距。
