Adolescent Reproductive Health Care: Views and Practices of Pediatric Hospitalists

Abstract

A B S T R A C TBACKGROUND AND OBJECTIVES: Many hospitalized adolescents are at increased risk for pregnancy complications due to an underlying medical condition, however sexual risk assessment is not consistently performed in this setting. While adolescents and their parents are supportive of sexual health discussion in the inpatient setting, a thorough understanding of factors that influence provision of this care among pediatric hospital physicians is lacking. This formative information is needed to facilitate efforts to improve and standardize clinical care provision. Our objective is to assess the frequency and factors that influence the provision of adolescent sexual and reproductive care by pediatric hospitalists. METHODS:We performed a cross-sectional computerized survey of hospitalists at 5 pediatric hospitals who cared for $1 adolescent (14-21 years old) in the past year. Sexual and reproductive care practices were assessed by using a 76-item novel survey informed by the theory of planned behavior. We used descriptive statistics to summarize the data. RESULTS:Sixty-eight pediatric hospitalists participated (49% response rate): 78% were women and 65% were aged ,40 years. Most (69%) reported treating .46 adolescents annually, including many who are at an increased risk for pregnancy complications due to teratogenic medication use or a comorbid condition. A majority felt that sexual and reproductive services are appropriate, although many endorsed barriers, including concern about follow-up after emergency contraception (63%) and time constraints (53%). Most reported insufficient knowledge regarding contraception (59%), desired contraception education (57%), and were likely to increase contraceptive provision if provided education (63%). Hospitalists rarely provided condoms or referral for an intrauterine device.CONCLUSIONS: Pediatric hospitalists frequently care for adolescents who are at risk for pregnancy complications and generally agree that reproductive care is appropriate in the inpatient setting. With these findings, we highlight the critical need for effective comprehensive reproductive health service interventions that are tailored to address the numerous actionable barriers identified in this study. d Division of Health Services and OutcomesResearch and

Health Professional’s Knowledge and Attitude Regarding Adolescent Pregnancy Care in Primary Health Care Centers in Erbil City

“…This is because stress is assumed to place individuals at increased risk for depression, anxiety, and other emotional problems [17].The present study reveals that 58.2% of the physicians had high knowledge scores compared with 35.0% of the nurses (p = 0.032). This agreed to the finding of the study that done byMasonbrink et al, (2019) reported that most respondents had insufficient knowledge regarding adolescent's reproductive health care (59%) [18]. This study is also consistent with the other study was done on adolescent mothers and health centers staff by Sychareun et al (2018) they were reported that adolescent mothers reported in their study, low utilization of sexual and maternal health services was common, and adolescent specific services were unavailable.…”

Barriers to Tobacco Cessation for Caregivers of Hospitalized Children: Perspectives of Pediatric Hospitalists

“…However, we were able to enroll a study sample representing multiple regions of the country with characteristics consistent with the majority of pediatric hospitalists practicing in the United States (eg, mostly female, ,40 years old). 24,25 Trainees were excluded from our study because of variability in their practice location and clinical subspecialty; however, they may play a role in tobacco cessation care provision to caregivers of hospitalized children. We relied on participant selfreporting to assess their perceptions of practices, which is susceptible to response and social desirability biases.…”

Caring for Hospitalized Adolescents: Opportunities to Identify and Address Unmet Reproductive Health Needs

“…Despite expressing the desire to discuss reproductive care with their providers, adolescents report concerns regarding confidentiality, and poor access to care due to transportation and costs [15,16]. Furthermore, pediatricians report barriers to provision of reproductive care for adolescents due to time constraints, lack of knowledge or comfort, and concerns regarding policies governing minor consent for care [17,18]. Because of these barriers, only 30% of adolescents report having a confidential conversation with their physician, 40% report that they were screened for sexual activity by their primary care physician, and less than one half of sexually active adolescents received counseling regarding contraception and STI prevention [19,20].…”

“…Mental health and/or substance use disorders are among the most common reasons for hospitalizations in adolescents and are independently associated with high-risk sexual behaviors (e.g., unprotected sex, multiple sexual partners) [26,27]. In addition, many hospitalized adolescents are at risk for pregnancy complications due to underlying medical conditions (e.g., diabetes) or use of teratogenic medications [18,23,24]. Nearly half of hospitalized adolescents report having not received safe sex counseling from their primary care provider, and 41% are interested in learning more about contraception and/or abstinence during their hospital stay [28].…”

“…The pediatric hospital setting is uniquely equipped to address unmet reproductive care needs, given specific advantages such as prolonged providerepatient interactions across multiple days and the opportunity for confidential conversations when caregivers are not present. Previous studies show that although pediatric hospitalists agree that it is appropriate to provide reproductive services, most only infrequently offer safer sex counseling, condoms, or referral for contraception [18,30]. McFadden et al confirm that screening for sexual activity and unmet reproductive health needs does not routinely occur.…”