Background: Adolescent reproductive health services are essential to prevent transmission of sexually transmitted infections (STIs) and teen pregnancy. Half of all new STIs occur among 15-24 year-olds and approximately 750,000 teenage females become pregnant per year. Adolescents have poor access to preventive care, and even when seen in the primary care setting, reproductive health is often not addressed. The hospital setting may provide an optimal opportunity to address this need, yet reproductive healthcare is not often discussed during hospitalization. Preliminary research, from our institution, demonstrated only 55% of hospitalized adolescents had any documentation of sexual history, with males, patients admitted directly to the intensive care unit (ICU), and those hospitalized for non-ingestion complaints, with even less documentation. The objective of this study was to increase provision of reproductive health services within the hospital setting with implementation of a reproductive health services initiative.
Methods: This is a prospective study from 5/1/17 to 9/30/18 at a stand-alone academic children’s hospital, with baseline data from 5/1/17 to 7/31/17 and post intervention data from 7/1/18 to 9/30/18. Reproductive health services initiative consisted of: resident education, presentation of current institutional practice habits, development of electronic health record template, creation of teen health cards with electronic educational materials on reproductive health for adolescents and availability of free condoms to be offered to all patients 14 years and older. Data collected included patient demographics, sexual history (any documentation of sexual history within the entire hospital encounter) and provision of reproductive health services such as STI testing/treatment and HPV immunization. Balancing measures included length of stay and patient relations consults. Data analyzed using descriptive statistics and unpaired T tests, alpha <0.05.
Results: 147 patients were included in the baseline data and 147 patients in the post-intervention. Overall, documentation of sexual history significantly increased (55% vs 84%, p<0.01) as did STI testing (12% vs 23%, p<0.01). Documentation significantly increased for males (36% vs 75%, p<0.01), patients admitted directly to the ICU (14% vs 67%, p<0.01) and non-ingestion complaints (47% vs 83%, p<0.01). STI testing significantly increased for non-ingestion complaints (10% vs 23%, p=0.02). STI testing increased, but not significantly, for males (5% vs 9%, p=0.47) and patients admitted directly to the ICU (0% vs 17%, p=0.12). HPV immunization of adolescents due for immunization did not increase (18% vs 15%, p=0.57). Potential negative consequences of this initiative such as prolonged length of stay or increased patient relations consults were not observed.
Conclusions: Overall sexual history documentation and STI testing increased following initiation of a reproductive health initiative, with improvement noted in certain sub-populations as well.