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Sexual health surveys improve STI screening among youth in ED
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ED clinicians receiving decision-making support via an audio-computer–assisted self-interview sexual health survey resulted in increased testing rates for sexually transmitted infections among high-risk adolescents, according to research presented at the 2016 AAP National Conference and Exhibition.
“Adolescents have the highest rates of STIs of any age group, and the ED often represents their only access to health care,” Monika Goyal, MD, MSCE, assistant professor in the department of pediatrics at Children’s National Health System at George Washington University, told Infectious Disease News. “Therefore, if we could develop a mechanism to effectively, confidentially, and efficiently identify adolescents in the ED who may be at risk for STIs, the ED could provide a strategic setting for the detection, treatment and prevention of STIs.”
To study whether providing ED clinicians with STI risk assessments through a clinical decision support process results in increased rates of screening among at-risk teens, the researchers conducted a two-arm randomized trial at a single, urban pediatric ED. Adolescents aged 14 to 19 years (n = 728) completed an audio computer-assisted self-interview sexual health survey. For those assigned to the intervention group, the attending physician was provided with clinical decision support for STI screening based on the assigned STI risk. Physicians with patients in the usual care group did not receive this recommendation.
Patients were classified as “high risk” — with screening “highly recommended” — if they disclosed being sexually active, reported at least one sexual partner in the past 3 months, failed to use a condom during their last sexual encounter, had a prior history of STIs or had the presence of STI symptoms.
According to Goyal and colleagues, 635 of the enrolled patients — 323 in the intervention group and 312 in the control group — provided data that could be evaluated. In all, 52.3% of patients in the intervention group and 42% in the control group who were determined to be at “high risk” underwent STI screening (adjusted OR = 2; 95% CI, 1-3.8). In addition, among the 475 adolescents with non-STI–related chief complaints who were determined to be at “high risk,” 28.6% in the intervention group and 8.2% in the control group underwent STI testing (aOR = 4.7; 95% CI, 1.4, 15.5).
“This work is significant because it demonstrates that a process of electronically collected patient-reported data to guide decision-making can lead to improved STI testing rates,” Goyal said. “The goal of our future work is to integrate this decision support into the electronic health record and to evaluate whether it leads to improved rates of STI detection and treatment.” – by Jason Laday
- Reference:
- Goyal M, et al. Clinical decision support using computerized sexual health surveys improves STI screening rates among high-risk adolescents in a pediatric emergency department: A randomized trial. Presented at: AAP National Conference and Exhibition; Oct. 22-25; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.