Mehta Sonia, Porada Kelsey, Liegl Melodee, Pan Amy, McFadden Vanessa
Department of Pediatric Emergency Medicine, University of California San Francisco Benioff Children's Hospitals, San Francisco, California.
Department of Pediatrics, Sections of Hospital Medicine.
Hosp Pediatr. 2023 Feb 1;13(2):147-155. doi: 10.1542/hpeds.2022-006580.
To fill access gaps for adolescents, addressing sexual and reproductive health (SRH) is recommended in nontraditional settings. In previous improvement work, we increased documentation of sexual history to >80% of adolescents hospitalized on our pediatric hospital medicine (PHM) service. This study assessed adolescents' perception of SRH conversations with hospital providers and the extent to which they were helpful.
Postdischarge survey of patients 13 to 17 years discharged from the PHM service at an academic children's hospital between August 2019 and March 2020. Survey items included demographics; whether confidential discussion of sexual health topics such as contraception, sexually transmitted infection (STI), and sexual orientation occurred; perceptions of these discussions, and sexual history.
Eighty-three patients enrolled and 44 (53%) completed the survey after discharge. A total of 68% of respondents were female and median age was 15 years (interquartile range 14-16). A total of 77% reported discussing SRH privately with a PHM provider. A total of 18% recalled discussing condoms, and 63% rated the discussion helpful. A total of 27% of females reported discussing birth control, and 40% rated it helpful. A total of 57% recalled discussing sexual orientation, and 40% rated it helpful. None reported discussions of STI testing with PHM. Of the 23% who were sexually active, none reported being given condoms.
Analysis of adolescent patient experiences identified opportunities for continued improvement in the content and quality of SRH discussions, specifically regarding offering STI testing, condom distribution, and sexual orientation conversations. Our work highlights the importance of incorporating patient-reported data into improvement work to ensure providers are addressing targeted gaps in adolescent care.
为填补青少年的医疗服务空白，建议在非传统环境中解决性与生殖健康（SRH）问题。在之前的改进工作中，我们将青少年性病史的记录比例提高到了在我们儿科医院医学（PHM）服务部门住院的青少年的80%以上。本研究评估了青少年对与医院提供者进行的SRH对话的看法以及这些对话的帮助程度。
对2019年8月至2020年3月期间在一家学术儿童医院的PHM服务部门出院的13至17岁患者进行出院后调查。调查项目包括人口统计学信息；是否进行了关于避孕、性传播感染（STI）和性取向等性健康话题的保密讨论；对这些讨论的看法以及性病史。
83名患者登记参与，44名（53%）在出院后完成了调查。共有68%的受访者为女性，中位年龄为15岁（四分位间距14 - 16岁）。共有77%的受访者报告与PHM提供者私下讨论了SRH。共有18%的人回忆起讨论了避孕套，63%的人认为该讨论有帮助。共有27%的女性报告讨论了节育措施，40%的人认为有帮助。共有57%的人回忆起讨论了性取向，40%的人认为有帮助。没有人报告与PHM讨论过STI检测。在有性活动的23%的人中，没有人报告被提供过避孕套。
对青少年患者经历的分析确定了在SRH讨论的内容和质量方面持续改进的机会，特别是在提供STI检测、分发避孕套和进行性取向对话方面。我们的工作强调了将患者报告的数据纳入改进工作的重要性，以确保提供者解决青少年护理中的目标差距。
