Associations between gynecologic clinician type and routine female sexual dysfunction screening

BACKGROUND

Female sexual dysfunction (FSD) is a common problem in the United States; however, only 14% to 40% of women are screened by their health care clinicians. There are few data on how differences in clinician type affects screening rates.

AIM

This study aimed to assess differences in FSD screening rates among gynecology clinician types, identify factors associated with screening, and compare screening rates of FSD against conditions with established screening recommendations.

METHODS

Data were collected by retrospective chart review of annual visits at an urban tertiary care center. Screening rates for FSD, depression, cervical cancer, and breast cancer were calculated and compared. Multivariable logistic regression modeling was utilized to assess the correlation between various patient characteristics and FSD screening rates.

OUTCOMES

Study outcome measures included percentages of women who were screened for FSD, depression, cervical cancer, and breast cancer.

RESULTS

FSD screening rate was significantly higher among resident-level clinicians vs nonresident clinicians (59% vs 31%; P < .001). When the nonresident clinicians were subanalyzed, certified nursing midwives were the second most likely to screen for FSD (odds ratio [OR], 0.41), followed by nurse practitioners (OR, 0.29) and attending physicians (OR, 0.22). According to multivariable logistic regression techniques, 5 factors were associated with an increased likelihood of a patient being screened for FSD at an annual examination: patient seen by a resident physician rather than an attending physician, patient history of FSD, patient age ≥40 years, patient report of being sexually active at the time of visit, and patient history of cervical procedures.

CLINICAL IMPLICATIONS

There is an opportunity to improve FSD screening rates by clinicians. Future research may assess what factors, such as increased sexual function education or greater incentives to document FSD screening, may result in higher screening rates. From this, targeted and effective interventions might be crafted to improve future screening rates.

STRENGTHS AND LIMITATIONS

This study is one of the first to compare FSD screening rates among clinician types in the same specialty. Study limitations include the inherent limitations of a retrospective design, including selection biases.

CONCLUSION

Residents were more likely to screen for FSD at annual well-woman visits than attending clinicians, nurse practitioners, and certified nurse midwives. Understanding the reasons for varied FSD screening rates among clinician types may aid in the development of strategies to improve screening for this important aspect of women's health.

Human papillomavirus vaccination receipt and provider counseling rates among high-risk patients

OBJECTIVE

We describe provider documented counseling patterns and perception regarding HPV vaccination among patients with a history of cervical dysplasia.

METHODS

All patients ages 21-45 who underwent colposcopy at a single academic medical center from 2018 to 2020were sent a self-administered survey through the electronic medical record patient portal to assess their attitudes regarding human papillomavirus (HPV) vaccination. Demographic information, HPV vaccination history, and documented obstetrics and gynecology provider counseling at the time of colposcopy were examined.

RESULTS

Of 1465patients, 434 (29.6 %) reported or had documented receipt of at least one dose of the human papillomavirus vaccine. The remainder reported they were not vaccinated or had no documentation of vaccination. Proportion of vaccinated patients was higher among White compared to Black and Asian patients (P = 0.02). On multivariate analysis, private insurance (aOR 2.2, 95 % CI 1.4-3.7) was associated with vaccinated status while Asian race (aOR 0.4, 95 % CI 0.2-0.7) and hypertension (aOR 0.2, 95 % CI 0.08-0.7) were less likely to be associated with vaccination status. Among patients with unvaccinated or unknown vaccination status, 112 (10.8 %) received documented counseling regardingcatch-up human papillomavirus vaccination at a gynecologic visit. Patients seen by a sub-specialist obstetrics and gynecologic provider were more likely to have documented provider counseling regarding vaccination compared to those seen by a generalist obstetric/gynecologist provider (26 % vs 9.8 %, p < 0.001). Patients cited lack of physician discussion (53.7 %) and the belief that they were too old to receive the HPV vaccine (48.8 %) as the main reasons for remaining unvaccinated.

CONCLUSION

HPV vaccination and the rate of obstetric and gynecologic provider counseling regarding HPV vaccination among patients undergoing colposcopy remains low. When surveyed, many patients with a history of colposcopy cited provider recommendation as afactor in their decision to undergo adjuvant HPV vaccination, demonstrating the importance of provider counseling in thisgroup.

Synthesis, Characterization and Enhanced Cleavage of Diphosphate and Triphosphate Bound to Tetraaminecobalt(III) Centers. Crystal Structure of [N,N-Bis(2-aminoethyl)ethane-1,2-diamine](diphosphato)cobalt(III) Perchlorate Monohydrate

The complexes [Co( tren )(P2O7H2)] (ClO4).H2O, [Co( tren )(P3010H3)] (ClO4) (tren = N,N-bis(2- aminoethyl )ethane-1,2-diamine) and [Co( cyclen )(P2O7H2)](ClO4)(cyclen = 1,4,7,10-tetraazacy-clododecane ) have been prepared and characterized. The complex [Co( tren )(P207H2)](C104).H20 crystallized in the monoclinic space group P21/n,a 10.655(3), b 14.675(5), c 11.260(4) � , β 98.49(3) for a single-crystal structure determination R was 0.041 for 4043 'observed' reflections. Despite the presence of a primary and a tertiary nitrogen donor in the plane of the cobalt and the phosphate oxygen donors, bond distances to Co-N(primary) and Co-N(tertiary) at 1.926(3) and 1.924(3) � respectively are equivalent, as are the Co-O distances of 1.940(2) and 1 .943(3) to the N(primary) and N(tertiary) respectively. Axial Co-N(primary) bonds (av. 1.952 A) are elongated compared with the in-plane N(primary), and the axial N-Co-N angle is distorted (171.6�). The hydrolysis of the diphosphate and triphosphate complexes at pH 7.3 in the presence of an assisting complex, [Co( tn )2(OH2)(OH)]2+ ( tn = propane-1,3-diamine) or [Co( tren )(OH2)(0H)]2+, was followed by 31P n.m.r. spectroscopy, and rate enhancements of up to about 104 compared with free polyphosphate were observed, with the diphosphato complexes being least sensitive to cleavage by added complex. Intermediates in which the polyphosphate bridges two metal centres are apparently involved; the inability of [Pd(en)(0H2)2]2+(en= 1,2-ethanediamine) to enhance cleavage is consistent with this, since this ion does not form complexes with polyphosphates. [Co( tren )(ATP)](ATP=adenosine triphosphate ) was also prepared but not isolated; assisted hydrolysis with [Co( tren )(OH2)(OH)]2+ is about 104 faster than unassisted hydrolysis of free ATP under similar conditions.