1
|
Solnick RE, López LH, Martinez PM, Zucker JE. Sexually Transmitted Infections in the Emergency Department. Emerg Med Clin North Am 2024; 42:335-368. [PMID: 38641394 DOI: 10.1016/j.emc.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
As the United States faces a worsening epidemic of sexually transmitted infections (STIs), emergency departments (EDs) play a critical role in identifying and treating these infections. The growing health inequities in the distribution and disproportionate impact of STIs add to the urgency of providing high-quality sexual health care through the ED. Changes in population health are reflected in the new Centers for Disease Control recommendations on screening, diagnostic testing, and treatment of STIs. This review covers common, as well as and less common or emerging STIs, and discusses the state-of-the-art guidance on testing paradigms, extragenital sampling, and antimicrobial treatment and prevention of STIs.
Collapse
Affiliation(s)
- Rachel E Solnick
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA.
| | - Laura Hernando López
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Patricia Mae Martinez
- Icahn School of Medicine at Mount Sinai Hospital, Department of Emergency Medicine- Research Division, 555 West 57th Street, 5th Floor Suite 5-25, New York, NY 10019, USA
| | - Jason E Zucker
- Columbia University Vagelos College of Physicians and Surgeons, 630 West 168th Street, Box 82, New York, NY 10032, USA
| |
Collapse
|
2
|
Salas-Marquez C, Bosch García R, Repiso Jiménez JB, Clavo Escribano P, Rivas Ruiz F. Development of a Questionnaire on Knowledge, Habits, and Attitudes on Sexually Transmitted Infections in Teenagers and Young Adults. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:387-392. [PMID: 38065318 DOI: 10.1016/j.ad.2023.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/30/2023] [Accepted: 07/03/2023] [Indexed: 12/26/2023] Open
Abstract
Communication with teenagers who are significantly affected by sexually transmitted infections (STIs) is essential for the sake of prevention. The aim of this study is to develop a specific questionnaire for surveying the degree of knowledge, behavior, and attitudes of current teenagers and young adults on STIs to come up with the proper training tools. We conducted the study following the Delphi method, a 2-round critical assessment score (from 1 to 9) of all domains and items. Only domains and items with median scores ≥8 were selected. A total of 8 panelists were involved in this survey. After establishing a median score ≥8, a total of 14 domains and 40 items were eventually selected. This is the first questionnaire ever conducted to study the knowledge, habits, and attitudes of contemporary teenagers and young adults on STIs, and stands as a valuable tool for future training on STI prevention in teenagers and young adults.
Collapse
Affiliation(s)
- C Salas-Marquez
- Área de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, Spain; Programa de Doctorado, Biomedicina, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.
| | - R Bosch García
- Departamento de Medicina y Dermatología, Área de Dermatología y Venereología, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Área de Dermatología y Venereología, Hospital Clínico Virgen de la Victoria, Málaga, Spain
| | - J B Repiso Jiménez
- Área de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - P Clavo Escribano
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - F Rivas Ruiz
- Área de Investigación, Hospital Costa del Sol, Marbella, Málaga, Spain
| |
Collapse
|
3
|
Salas-Marquez C, Bosch García R, Repiso Jiménez JB, Clavo Escribano P, Rivas Ruiz F. Development of a Questionnaire on Knowledge, Habits, and Attitudes on Sexually Transmitted Infections in Teenagers and Young Adults. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T387-T392. [PMID: 38331169 DOI: 10.1016/j.ad.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/03/2023] [Indexed: 02/10/2024] Open
Abstract
Communication with teenagers who are significantly affected by sexually transmitted infections (STIs) is essential for the sake of prevention. The aim of this study is to develop a specific questionnaire for surveying the degree of knowledge, behavior, and attitudes of current teenagers and young adults on STIs to come up with the proper training tools. We conducted the study following the Delphi method, a 2-round critical assessment score (from 1 to 9) of all domains and items. Only domains and items with median scores ≥8 were selected. A total of 8 panelists were involved in this survey. After establishing a median score ≥8, a total of 14 domains and 40 items were eventually selected. This is the first questionnaire ever conducted to study the knowledge, habits, and attitudes of contemporary teenagers and young adults on STIs, and stands as a valuable tool for future training on STI prevention in teenagers and young adults.
Collapse
Affiliation(s)
- C Salas-Marquez
- Área de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España; Programa de Doctorado, Biomedicina, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - R Bosch García
- Departamento de Medicina y Dermatología, Área de Dermatología y Venereología, Facultad de Medicina, Universidad de Málaga, Málaga, España; Área de Dermatología y Venereología, Hospital Clínico Virgen de la Victoria, Málaga, España
| | - J B Repiso Jiménez
- Área de Dermatología y Venereología, Hospital Costa del Sol, Marbella, Málaga, España
| | - P Clavo Escribano
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, España
| | - F Rivas Ruiz
- Área de Investigación, Hospital Costa del Sol, Marbella, Málaga, España
| |
Collapse
|
4
|
Fernandez A, Lozano A, Lee TK, Prado G. Screening for Adolescent Risk Behaviors: Preliminary Evidence for a Family Functioning Tool. Int J Behav Med 2023:10.1007/s12529-023-10209-7. [PMID: 37580481 DOI: 10.1007/s12529-023-10209-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Family functioning is associated with adolescent drug use, alcohol use, cigarette use, and sexual risk behaviors. Assessing adolescents for family functioning, commonly associated with multiple risk behaviors, may help identify adolescents at risk for adverse health outcomes. This study examined whether a latent family functioning construct, encompassing multiple dimensions of family functioning, was associated with adolescents' substance use and sexual risk behaviors. METHOD This study used data harmonization with three intervention trials, including data from 1451 adolescents (M = 13.6, SD = 1.0), to perform a full-information item bifactor analysis on 46 family functioning items from five pre-existing family functioning measures. Regression analysis was used to examine the association between the identified subset of items and the following outcomes: cigarette use, alcohol use, drug use, and condom use. RESULTS Bifactor analysis identified a 26-item latent family functioning construct. Regression analysis indicated that a 26-item latent family functioning construct was associated negatively with lifetime and past 90-day cigarette use, alcohol use, and drug use. CONCLUSION In sum, the multi-dimensional latent family functioning construct may target specific barriers to risk screening in adolescent populations, including time constraint, hesitancy in discussing sensitive health topics, and use culturally appropriate and age-appropriate assessments.
Collapse
Affiliation(s)
- Alejandra Fernandez
- Department of Health Promotion and Behavioral Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Dallas, TX, USA.
| | - Alyssa Lozano
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| | - Tae Kyoung Lee
- Department of Child Psychology and Education/Social Innovation Convergence Program, Sungkyunkwan University, Seoul, South Korea
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
5
|
Gautam R, Orrino J. Improving chlamydia risk screening by using the CDC's 5 Ps approach to sexual health history. J Am Assoc Nurse Pract 2023; 35:441-448. [PMID: 36728254 DOI: 10.1097/jxx.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chlamydia trachomatis is infecting service members (SMs) at a rate of two to three times that of the U.S. population. Currently, the military only screens female SMs under the age of 25 years, leaving many at-risk males to go undetected leading to further transmission. LOCAL PROBLEM Service members are not routinely assessed for high-risk sexual activities, leading to increased chlamydia rate in Fort Bragg. At the primary care project site, screening was only done per HEDIS measure leading to only 5% STI positivity rate. The purpose of this project was to identify and screen SMs who are at high risk for chlamydia using the CDC's 5 Ps approach. METHODS This project took place at a large primary care clinic that only cared for active-duty soldiers over a 3-month period. INTERVENTIONS The CDC's 5 Ps questionnaire was administered to SMs 30 years and younger during routine appointments. The SMs deemed high risk from the questionnaire were screened using urine G/C NAAT testing. RESULTS Four hundred forty-nine SMs were assessed using the CDC's 5 Ps approach. The questionnaire identified 91 SMs (20%) at higher risk for STIs. Of the 45 urine samples submitted, six were positive for STIs. Of the six positive cases, five were male. Targeted screening resulted in 13.3% positive rate compared with the 5% in the current practice. CONCLUSION The result suggests that targeted screening of young males and females can identify high-risk sexual behaviors leading to increased findings of asymptomatic chlamydia carriers, ultimately leading to decreased chlamydia incidence.
Collapse
Affiliation(s)
- Ramesh Gautam
- Sledgehammer Troop Medical Clinic, Fort Benning, Georgia
| | - Jacob Orrino
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University, Bethesda, Maryland
| |
Collapse
|
6
|
Kilander H, Alehagen S, Hammarström S, Golsäter M. Identifying sexual risk-taking and ill health in the meeting with young people-experiences of using an assessment tool. Scand J Caring Sci 2022; 36:1189-1196. [PMID: 35445754 PMCID: PMC9790609 DOI: 10.1111/scs.13081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/27/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Identifying young people exposed to sexual risk-taking or violence is fundamental, when seeking to strengthen their health. However, young people seldom share sexual health concerns or experiences of violence with healthcare professionals (HCPs). Studies evaluating how use of a risk assessment tool influences the dialogue about sexual health and violence are sparse. AIMS The aim of this study was to explore HCPs' experiences of using the SEXual health Identification Tool (SEXIT) in encounters with young people at Swedish youth clinics. METHOD Three focus group interviews were conducted with 21 HCPs from nine youth clinics, where SEXIT had been introduced. Data were analysed using thematic content analysis. RESULTS Three themes were identified. The theme, Facilitates dialogue about sexuality and vulnerability, describes how the questionnaire pertaining to SEXIT helped to normalise and help both HCPs and young people to take part in the dialogue about sensitive issues. Need for a trustful encounter presents HCPs' ethical concerns regarding how the questionnaire affects the integrity of young people and trust-making. Sensitive topics entail challenges describes HCPs' challenges when dealing with sensitive issues. Additionally, it describes needs for knowledge and collaboration when targeting vulnerable young people. CONCLUSIONS The HCPs stated that using SEXIT developed their ability to address sensitive issues and helped both them and young people to take part in the dialogue about sexuality and exposure to violence. SEXIT involves experiences of ethical concerns regarding integrity and trust-making. It also entails challenges in having dialogues about sensitive issues, how to deal with risk assessment outcomes and in improvements regarding inter-professional collaborations.
Collapse
Affiliation(s)
- Helena Kilander
- Jönköping Academy for Improvement of Health and Welfare, School of Health and WelfareJönköping UniversityJönköpingSweden,Department of Women’s and Children’s HealthKarolinska InstitutetStockholmSweden,Department of Obstetrics and GynaecologyEksjö HospitalJönköpingSweden,Linköping UniversityLinköpingSweden,Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Siw Alehagen
- Division of Nursing Sciences and Reproductive Health, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Sofia Hammarström
- Region Västra GötalandKnowledge Centre for Sexual HealthGothenburgSweden,Division of Society and Health, Department of Health, Medicine and Caring SciencesLinköping UniversityLinköpingSweden
| | - Marie Golsäter
- CHILD ‐ Research Group, School of Health and WelfareJönköping UniversityJönköpingSweden,Child Health ServicesJönköpingSweden,Department of Biomedical and Clinical SciencesLinköping UniversityLinköpingSweden
| |
Collapse
|
7
|
Thomas-Smith S, Klein EJ, Strelitz B, Jensen J, Parker E, Richardson L, McCarty CA, Shafii T. Electronic Screening for Adolescent Risk Behaviors in the Emergency Department: A Randomized Controlled Trial. West J Emerg Med 2022; 23:931-938. [PMID: 36409949 PMCID: PMC9683771 DOI: 10.5811/westjem.2022.7.55755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION In this study we aimed to assess the impact of an electronic health assessment with individualized feedback for risk behaviors in adolescents seeking care in a pediatric emergency department (ED). METHODS We conducted a randomized control trial using a tablet-based screening program with a study population of adolescents in a busy pediatric ED. The intervention group received the screening program with individualized feedback. The control group received the screening program without feedback. All participants received one-day and three-month follow-up surveys to assess behaviors and attitudes toward health behaviors. RESULTS A total of 296 subjects were enrolled and randomized. There was no difference in changes in risky behaviors between the control and experimental groups. A higher proportion of participants in the intervention groups reported that the screener changed the way they thought about their health at one-day follow-up (27.0%, 36/133) compared to the control group (15.5%, 20/129, P = .02). CONCLUSION This study successfully tested a multivariable electronic health screener in a real-world setting of a busy pediatric ED. The tool did not significantly change risky health behaviors in the adolescent population screened. However, our finding that the intervention changed adolescents' perceptions of their health opens a door to the continued development of electronic interventions to screen for and target risk behaviors in adolescents in the ED setting.
Collapse
Affiliation(s)
- Siobhan Thomas-Smith
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Eileen J Klein
- University of Washington, Seattle Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Seattle, Washington
| | - Bonnie Strelitz
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Jennifer Jensen
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Elizabeth Parker
- Center for Clinical and Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Laura Richardson
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Carolyn A McCarty
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| | - Taraneh Shafii
- University of Washington School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, Seattle, Washington
| |
Collapse
|
8
|
Sheele JM, Bragg KJ, Bragg B, Campos SC, Elkins JM, Niforatos JD, Thompson CL. Descriptive Epidemiology of Women in the Emergency Department With Gonorrhea and Chlamydial Infection in the United States. Adv Emerg Nurs J 2022; 44:144-157. [PMID: 35476693 DOI: 10.1097/tme.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Demographic characteristics, risk factors, and clinical variables associated with gonorrhea and chlamydial infection in women being treated in emergency departments (EDs) in the United States are incompletely characterized. We used univariable and multivariable regression analyses on 17,411 encounters from women 18 years and older who presented to EDs in northeast Ohio and were tested for gonorrhea or chlamydial infection. There were 1,360 women (7.8%) who had Chlamydia trachomatis infection and 510 (2.9%) who had Neisseria gonorrhoeae infection. Those infected with C. trachomatis or N. gonorrhoeae were younger (23.8 vs. 29.2 years), unmarried (97.7% vs. 90.1%), Black (93.3% vs. 88.0%), infected with Trichomonas vaginalis (39.9% vs. 27.2%), diagnosed with urinary tract infection (15.7% vs. 10.6%), and treated for gonorrhea and chlamydial infection during the ED visit (31.6% vs. 17.4%) (all ps < .001). Women infected with C. trachomatis or N. gonorrhoeae had more urine white blood cells (WBCs) (23.9 vs. 16.4 cells per high-power field [HPF]) and leukocyte esterase (1.2+ vs. 0.8+) on urinalysis. They had more WBCs (18.5 vs. 12.4 cells/HPF) and odds of having T. vaginalis infection (12.8% vs. 8.2%) on vaginal wet preparation (all ps < .001). Women infected with C. trachomatis were more likely to be younger and not Black; they were less likely to be treated for gonorrhea and chlamydial infection in the ED and to have lower levels of urine WBCs, leukocyte esterase, and blood than those infected with N gonorrhoeae (all ps ≤ .05).
Collapse
Affiliation(s)
- Johnathan M Sheele
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida (Drs Sheele, K. J. Bragg, and B. Bragg); Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland (Dr Niforatos); and Department of Nutrition, Case Western Reserve University, Cleveland, Ohio (Dr Thompson). Drs Cantillo Campos and Elkins (limited tenure) are research trainees at Mayo Clinic, Jacksonville, Florida
| | | | | | | | | | | | | |
Collapse
|
9
|
Langerman SD, Badolato GM, Goyal MK. Attitudes Toward Electronic Sexual Health Assessments Among Adolescents in the Emergency Department. Pediatr Emerg Care 2021; 37:e1164-e1167. [PMID: 31664011 DOI: 10.1097/pec.0000000000001947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Adolescents account for nearly half of all newly diagnosed sexually transmitted infection (STI) cases in the United States and frequently access health care via emergency departments (EDs). However, there are many barriers to ED-based STI screening. Electronic sexual health assessments may overcome some of these ED-specific barriers. Thus, the objective of this study was to assess adolescent attitudes toward electronic sexual health assessments to guide STI screening in the ED. METHODS This was a secondary analysis of data from 2 cross-sectional studies evaluating acceptability of electronic sexual health assessments in the pediatric ED. Study participants completed an electronic questionnaire that elicited sexual behavior information and attitudes toward electronic sexual health assessments. We interrogated the electronic health record to determine if sexual histories were documented, and if so, we assessed patient preference for mode of assessment. We performed multivariable logistic regression to identify demographic factors associated with acceptance of electronic sexual health assessments. RESULTS Of the 1159 adolescents surveyed, 935 (80.7%; 95% confidence interval, 78.3-82.9) found electronic assessments an acceptable method by which to provide sexual health information. The majority (n = 874 [75.4%]; 72.8-77.9) reported a preference for electronic assessments over other modes of assessment. Acceptance of electronic assessments was associated with STI-related chief complaint (adjusted odds ratio, 1.7; 1.0-2.7) and private insurance (adjusted odds ratio, 1.8; 1.2-2.7). CONCLUSIONS Electronic sexual health assessments are acceptable to adolescents and are an efficient alternative to face-to-face sexual health assessments. Future studies should focus on how best to integrate electronic assessments into the ED workflow.
Collapse
Affiliation(s)
- Steven D Langerman
- From the School of Medicine and Health Sciences, The George Washington University
| | | | | |
Collapse
|
10
|
Sheele JM, Niforatos JD, Elkins JM, Campos SC, Thompson CL. Prediction model for gonorrhea, chlamydia, and trichomoniasis in the emergency department. Am J Emerg Med 2021; 51:313-319. [PMID: 34798573 DOI: 10.1016/j.ajem.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE History and physical examination findings can be unreliable for prediction of genitourinary tract infections and differentiation of urinary tract infections from sexually transmitted infections (STIs). The study objective was to develop a prediction tool to more accurately identify patients with STIs. METHODS A retrospective review of 64,490 emergency department (ED) encounters between April 18, 2014, and March 7, 2017, where patients age 18 years or older had urinalysis and urine culture or testing for gonorrhea, chlamydia, or trichomonas, was used to develop a prediction model for men and women with Neisseria gonorrhoeae or Chlamydia trachomatis, or both, and for women with Trichomonas vaginalis. The data set was randomly divided into two-thirds discovery and one-third validation. Groups were assigned through a random number generator. Backward step regression modeling was used to identify the best model for each outcome. RESULTS With use of age, race, marital status, and findings from vaginal wet preparation (white blood cells [WBCs], clue cells, and yeast) and urinalysis (squamous epithelial cells, protein, leukocyte esterase, and WBCs), the models had areas under the receiver operating characteristic curve of 0.80 for men with N gonorrhoeae or C trachomatis, or both; 0.75 for women with N gonorrhoeae or C trachomatis, or both; and 0.73 for women with T vaginalis. CONCLUSIONS The model estimated likelihood of ED patients having STIs was reasonably accurate with a limited number of demographic and laboratory variables. In the absence of point-of-care STI testing, use of a prediction tool for STIs may improve antimicrobial stewardship.
Collapse
Affiliation(s)
- Johnathan M Sheele
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, United States of America.
| | - Joshua D Niforatos
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, United States of America
| | - Justin M Elkins
- Research Trainee, Mayo Clinic, Jacksonville, FL, United States of America
| | | | - Cheryl L Thompson
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, United States of America
| |
Collapse
|
11
|
Fortin K, Vasan A, Wilson-Hall CL, Brooks E, Rubin D, Scribano PV. Using Quality Improvement and Technology to Improve Social Supports for Hospitalized Children. Hosp Pediatr 2021; 11:1120-1129. [PMID: 34475224 DOI: 10.1542/hpeds.2020-005800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To develop and test the feasibility of a caregiver self-administered social needs screener, a Web-based searchable community resource map, and a process map for implementation of these tools as part of social needs screening and referral on a pediatric inpatient unit. METHODS A multidisciplinary team used quality improvement methodology to develop an electronic social needs screener, resource map Web site, and electronic health record enhancements. A process map for implementation of these tools was refined through plan-do-study-act cycles before full implementation. Weekly measures included the number of eligible caregivers screened, prevalence of reported social needs, and use of social work resources. RESULTS During the 22-week study period, 147 caregivers were screened and 2 declined to participate. Thirty-four percent of caregivers endorsed ≥1 social need. The most common needs identified were depressive symptoms (23%), food insecurity (19%), and need for assistance with utilities (10%). All participants received information about the resource map, and 99% of caregivers with an identified need met with a social worker during their admission. CONCLUSIONS Using quality improvement methodology and technology, the team implemented a new standardized process for addressing social needs on an inpatient unit. This led to identification of social needs in more than one-third of caregivers screened and provision of resource map information to all caregivers. These findings reinforce the importance of standardized assessment of social needs in the pediatric inpatient setting. The role of technology, including resource maps and electronic health record enhancements, was highlighted.
Collapse
Affiliation(s)
- Kristine Fortin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aditi Vasan
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab
| | | | | | - David Rubin
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,PolicyLab
| | - Philip V Scribano
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
12
|
Pfaff N, DaSilva A, Ozer E, Vemula Kaiser S. Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Pediatrics 2021; 147:peds.2020-020610. [PMID: 33785635 DOI: 10.1542/peds.2020-020610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Risky behaviors are the main threats to adolescents' health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. OBJECTIVE To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. DATA SOURCES Our data sources included PubMed (1965-2019) and Embase (1947-2019). STUDY SELECTION Studies were included on the basis of population (adolescents aged 10-25 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. DATA EXTRACTION Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. RESULTS Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (∼10%) but significant increases with clinician reminder implementation. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. Reported barriers were time constraints and limited resources. LIMITATIONS Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. CONCLUSIONS Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care.
Collapse
Affiliation(s)
| | | | - Elizabeth Ozer
- Division of Adolescent and Young Adult Medicine.,Office of Diversity and Outreach, and
| | - Sunitha Vemula Kaiser
- Departments of Pediatrics and.,Epidemiology and Biostatistics.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
| |
Collapse
|
13
|
Eckman MH, Reed JL, Trent M, Goyal MK. Cost-effectiveness of Sexually Transmitted Infection Screening for Adolescents and Young Adults in the Pediatric Emergency Department. JAMA Pediatr 2021; 175:81-89. [PMID: 33136149 PMCID: PMC7607492 DOI: 10.1001/jamapediatrics.2020.3571] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Adolescents and young adults compose almost 50% of all diagnosed sexually transmitted infection (STI) cases annually in the US. Given that these individuals frequently access health care through the emergency department (ED), the ED could be a strategic venue for examining the identification and treatment of STIs. OBJECTIVE To examine the cost-effectiveness of screening strategies for Chlamydia trachomatis and Neisseria gonorrhoeae (chlamydia and gonorrhea) in adolescents and young adults who seek acute care at pediatric EDs. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation is a component of an ongoing, larger multicenter clinical trial at the Pediatric Emergency Care Applied Research Network. A decision analytic model, created using literature-based estimates for the key parameters, was developed to simulate the events and outcomes associated with 3 strategies for screening and testing chlamydial and gonococcal infections in individuals aged 15 to 21 years who sought acute care at pediatric EDs. Data sources included published (from January 1, 1997, to December 31, 2019) English-language articles indexed in MEDLINE, bibliographies in relevant articles, insurance claims data in the MarketScan database, and reimbursement payments from the Centers for Medicare and Medicaid Services. Because the events and outcomes were simulated, a hypothetical population of 10 000 ED visits by adolescents and young adults was used. INTERVENTIONS The 3 screening strategies were (1) no screening, (2) targeted screening, and (3) universally offered screening. Targeted screening involved the completion of a sexual health survey, which yielded an estimated STI risk (at risk, high risk, or low risk). MAIN OUTCOMES AND MEASURES Outcome metrics included cost (measured in 2019 US dollars) and the detection and successful treatment of STIs. The incremental cost-effectiveness ratio (ICER) of each strategy was calculated in a base case analysis. The ICER reflects the cost per case detected and successfully treated. RESULTS A 3.6% prevalence of chlamydia and gonorrhea was applied to a hypothetical population of 10 000 ED visits by adolescents and young adults. Targeted screening resulted in the detection and successful treatment of 95 of 360 STI cases (26.4%) at a cost of $313 063, and universally offered screening identified and treated 112 of 360 STI cases (31.1%) at a cost of $515 503. The ICER for targeted screening vs no screening was $6444, and the ICER for universally offered screening vs targeted screening was $12 139. CONCLUSIONS AND RELEVANCE This economic evaluation found that targeted screening and universally offered screening compared with no screening appeared to be cost-effective strategies for identifying and treating chlamydial and gonococcal infections in adolescents and young adults who used the ED for acute care. Universally offered screening was associated with detecting and successfully treating a higher proportion of STIs in this population.
Collapse
Affiliation(s)
- Mark H. Eckman
- Division of General Internal Medicine and the Center for Clinical Effectiveness, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Jennifer L. Reed
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Department of Pediatrics, The University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Maria Trent
- Department of Pediatrics, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Monika K. Goyal
- Department of Pediatrics, Children's National Hospital, The George Washington University, Washington, DC
| |
Collapse
|
14
|
Gutman CK, Middlebrooks L, Camacho-Gonzalez A, Shah B, Belay Z, Morris CR. Asymptomatic Adolescent HIV: Identifying a Role for Universal HIV Screening in the Pediatric Emergency Department. AIDS Patient Care STDS 2020; 34:373-379. [PMID: 32799540 PMCID: PMC7480725 DOI: 10.1089/apc.2020.0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.
Collapse
Affiliation(s)
- Colleen K. Gutman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Lauren Middlebrooks
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andres Camacho-Gonzalez
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Division of Pediatric Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bijal Shah
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Zena Belay
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| |
Collapse
|
15
|
Shafii T, Levine D. Office-Based Screening for Sexually Transmitted Infections in Adolescents. Pediatrics 2020; 145:S219-S224. [PMID: 32358214 DOI: 10.1542/peds.2019-2056k] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 11/24/2022] Open
Abstract
Almost 1 in 4 adolescents have a sexually transmitted infection (STI). These infections are preventable through safe sexual practices and routine screening. Pediatricians are the first line of clinical care for adolescents and are well positioned to offer sexual and reproductive health care counseling and services to their patients; yet, there is a paucity of sexual health screening provided at routine health supervision visits. This article addresses the epidemiology of STIs in adolescents, reviews the evidence of current clinical practice, presents recommended STI screening from government and medical agencies, and offers strategies to address barriers to providing care for adolescents and for sexual health screening in primary care.
Collapse
Affiliation(s)
- Taraneh Shafii
- University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington; and
| | | |
Collapse
|
16
|
Shafii T, Benson SK, Morrison DM. Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study. J Med Internet Res 2019; 21:e13220. [PMID: 31293242 PMCID: PMC6652122 DOI: 10.2196/13220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. OBJECTIVE The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. METHODS At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. RESULTS The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. CONCLUSIONS In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents.
Collapse
Affiliation(s)
- Taraneh Shafii
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Samantha K Benson
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, United States
| | - Diane M Morrison
- School of Social Work, University of Washington, Seattle, WA, United States
| |
Collapse
|
17
|
Miller MK, Mollen C, Behr K, Dowd MD, Miller E, Satterwhite CL, Stancil S, Allen N, Michael J, Inboriboon PC, Park A, Goggin K. Development of a Novel Computerized Clinical Decision Support System to Improve Adolescent Sexual Health Care Provision. Acad Emerg Med 2019; 26:420-433. [PMID: 30240032 PMCID: PMC6625349 DOI: 10.1111/acem.13570] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The objective was to develop an acceptable clinical decision support (CDS) system to facilitate evidence-based sexual health care for adolescents in the emergency department (ED). METHODS In this multiphased iterative process, we engaged an expert group to synthesize evidence on a wide range of sexual health services (e.g., contraception, condoms, identification and treatment of previously diagnosed sexually transmitted infection). We created a computerized questionnaire and embedded our decision tree, utilizing patient-entered responses to create tailored, evidence-based recommendations, and embedded links to study-related resources such as the emergency contraception (EC) quick guide. We utilized mixed methodology to explore perspectives of adolescents aged 14 to 19 years and clinicians at two general and two pediatric EDs after they interacted with the system. Clinicians reported usefulness (Likert scale 1 = not at all, 4 = very); adolescents reported acceptability. We used the chi-square test to compare responses between subgroups. We collected adolescents' verbatim responses to open-ended questions; clinicians self-entered responses. Four authors independently generated themes from qualitative responses before compiling key findings and achieving consensus on final themes. RESULTS Among 57 clinicians (23 physicians, 23 nurses, 11 nurse practitioners; 54% female; 65% aged < 40 years), the mean system usefulness rating was 3.4 ± 0.7. Sex, age, clinician role, or ED type were not associated with rating the system "somewhat/very" useful. Clinicians identified barriers (e.g., time constraints) that could be overcome by implementation considerations (e.g., training) as well as benefits including improved care. For future assessments, providers preferred computer (65%) over face-to-face interview (26%). Among 57 adolescents (mean age = 16.2 years; 75% female; 56% sexually experienced), nearly all (95%) reported that it was "very/somewhat easy" to complete the computerized questionnaire and to understand the questions. Most adolescents understood the EC quick guide and correctly identified that ulipristal, compared to levonorgestrel, required a prescription and was more effective. For future assessments, adolescents preferred computer (69%) over face-to-face interviews (9%). CONCLUSIONS We developed a sexual health CDS system that is easy to use and can facilitate evidence-based care to reduce health outcome gaps. Evaluation of system impact on service delivery and, ultimately, health outcomes is needed.
Collapse
Affiliation(s)
- Melissa K. Miller
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Cynthia Mollen
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Kelli Behr
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - M. Denise Dowd
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Stephani Stancil
- Department of Pediatrics, Division of Adolescent Medicine, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Nancy Allen
- Department of Pediatrics, Office of Evidence-Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | - Jeffery Michael
- Department of Pediatrics, Division of Emergency Medical Services, Children’s Mercy Hospitals and Clinics, Kansas City, MO
- Department of Pediatrics, Office of Evidence-Based Practice, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| | | | - Andrew Park
- Department of Emergency Medicine, University of Kansas Hospital, Kansas City, KS
| | - Kathy Goggin
- Center for Health Services Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO
| |
Collapse
|
18
|
Use of Audio Computer-Assisted Self-Interviews to Gather Information on Risk Behaviors in a Population of Pregnant Adolescents. J Pediatr 2018; 203:450-453. [PMID: 30244989 DOI: 10.1016/j.jpeds.2018.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/18/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022]
Abstract
In a prospective study comparing the use of the Audio Computer-Assisted Self-Interview (ACASI) with a traditional clinical interview in 40 pregnant adolescents, there was significantly greater disclosure of violence with the ACASI method. Better identification of high-risk behaviors may help to optimize care and programing for pregnant adolescents.
Collapse
|
19
|
Miller MK, Pickett ML, Reed JL. Adolescents at Risk for Sexually Transmitted Infection Need More Than the Right Medicine. J Pediatr 2017; 189:23-25. [PMID: 28739182 DOI: 10.1016/j.jpeds.2017.06.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/29/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Melissa K Miller
- Division of Emergency Medicine Children's Mercy Hospital Kansas City, Missouri.
| | - Michelle L Pickett
- Division of Emergency Medicine Children's Hospital of Wisconsin Milwaukee, Wisconsin
| | - Jennifer L Reed
- Division of Emergency Services Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio
| |
Collapse
|
20
|
Goyal MK, Fein JA, Badolato GM, Shea JA, Trent ME, Teach SJ, Zaoutis TE, Chamberlain JM. A Computerized Sexual Health Survey Improves Testing for Sexually Transmitted Infection in a Pediatric Emergency Department. J Pediatr 2017; 183:147-152.e1. [PMID: 28081888 PMCID: PMC5440080 DOI: 10.1016/j.jpeds.2016.12.045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/27/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess whether clinical decision support, using computerized sexually transmitted infection (STI) risk assessments, results in increased STI testing of adolescents at high risk for STI. STUDY DESIGN In a 2-arm, randomized, controlled trial conducted at a single, urban, pediatric emergency department, adolescents completed a computerized sexual health survey. For patients assigned to the intervention arm, attending physicians received decision support to guide STI testing based on the sexual health survey-derived STI risk; in the usual care arm, decision support was not provided. We compared STI testing rates between the intervention and usual care groups, adjusting for potential confounding using multivariable logistic regression. RESULTS Of the 728 enrolled patients, 635 (87.2%) had evaluable data (323 intervention arm; 312 usual care arm). STI testing frequency was higher in the intervention group compared with the usual care group (52.3% vs 42%; aOR 2 [95% CI 1.1, 3.8]). This effect was even more pronounced among the patients who presented asymptomatic for STI (28.6 vs 8.2%; aOR 4.7 [95% CI 1.4-15.5]). CONCLUSIONS Providing sexual health survey-derived decision support to emergency department clinicians led to increased testing rates for STI in adolescents at high risk for infection, particularly in those presenting asymptomatic for infection. Studies to understand potential barriers to decision support adherence should be undertaken to inform larger, multicenter studies that could determine the generalizability of these findings and whether this process leads to increased STI detection. TRIAL REGISTRATION ClinicalTrials.gov: NCT02509572.
Collapse
Affiliation(s)
- Monika K Goyal
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC.
| | - Joel A Fein
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gia M Badolato
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Maria E Trent
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stephen J Teach
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC
| | - Theoklis E Zaoutis
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - James M Chamberlain
- Department of Pediatrics & Emergency Medicine, Children's National Health System, Washington, DC
| |
Collapse
|