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Sexual health surveys lead to increased STI screening among youth in ED
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SAN FRANCISCO — ED clinicians receiving decision-making support via an audio-computer-assisted self-interview sexual health survey resulted in increased sexually transmitted infections testing rates among high-risk adolescents, according to research presented at the 2016 AAP National Conference and Exhibition.
“Adolescents have the highest rates of sexually transmitted infections (STI) of any age group, and the emergency department (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 in Washington, D.C., told Healio Family Medicine. “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 2-arm randomized trial at a single, urban pediatric ED. Enrolled adolescents (n = 728) aged 14 to 19 years 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 “at high risk” for STI, with a screening being “highly recommended,” if they reported being sexually active, having more than 1 sexual partner within the past 3 months, failing to use a condom the last time they had sex, prior history of STI, or the presence of STI symptoms. “At risk” patients, for whom a screening was “recommended,” were those who reported being sexually active, but did not disclose any high-risk sexual behavior. Patients were classified as “low risk” if they claimed no history of sexual activity. The researchers calculated the differences in STI testing rates between the 2 groups.
According to Goyal and colleagues, 635 of the enrolled patients — 323 in the intervention group and 312 in the control — provided data that could be evaluated. In all, 52.3% of patients in the intervention group and 42% in the control who were determined to be “high risk” underwent STI screening (aOR = 2; 95% CI, 1-3.8). In addition, among the 475 participants with non-STI related chief complaints determined to be “high risk,” — 28.6% in the intervention group, and 8.2% in the control — 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; AAP National Conference & Exhibition, San Francisco, Oct. 21, 2016.
Disclosure: The researchers report no relevant financial disclosures.