Review of Clinical Trials Testing the Effectiveness of Clinician Intervention Approaches to Prevent Sexually Transmitted Diseases in Adolescent Outpatients

Abstract

Objective-Identify approaches for improving clinician provision of sexually transmitted diseases (STDs) prevention services among outpatient adolescents.Methods-Reviewed all peer-reviewed, published clinical trials identified through computerized searches (MEDLINE, PsychINFO) evaluating STD prevention services to outpatient adolescents by clinicians.Results-Five trials were identified examining changes in clinician provision of STD prevention services. Two of these trials resulted in adolescent self-reported risk reduction but neither of these trials effectively demonstrated reductions in objectively measured STD incidence. Nine clinical trials were identified that compared clinician with non-clinician provision of STD prevention services. Four of these trials resulted in adolescent self-reported risk reduction, and one of these trials demonstrated a reduction in objectively measured STD incidence.Conclusions-Trials indicate that improvement in outpatient adolescent STD incidence is possible with non-clinicians as interventionists, and perhaps clinicians as interventionists if clinicians are supported by other educational resources. Opportunities for personalized, interactive adolescent education appears key to intervention success. The clinician role that is tested in most trials is confined to a single brief encounter with little attention to: development of clinician skills, quality of psychosexual risk assessment and tailoring to meet individual adolescent need, systemslevel resources and supports, the parental role, or the impact of incorporating prevention into an ongoing adolescent-clinician relationship.

Will You Ask? Will They Tell You? Are You Ready to Hear and Respond?

“…16 Physician clinic staff may need to be involved in various aspects of adolescent sexuality assessment and education. 17 Healthcare systems may need to: Develop education programs and referral systems; provide more time for adolescent visits; reward physicians for meeting care recommendations; remove physician penalties for taking extra time with adolescents; develop policies that guide physician practice and protect physicians; and conduct patient panel epidemiology studies to help physicians be more focused on the sexual concerns their patients are most likely to experience. 15 Professional Associations may need to better provide physicians with: Education opportunities, role delineation, practice recommendations, and advocacy to overcome structural barriers to physician sexuality discussion.…”

“…Provision of sexual health assessment and counseling in primary care can reduce adolescents' sexual risks and should be pursued. 17,19 While parents, family members, teachers, coaches, faith leaders, and peers are important sources of sexual information; primary care physicians have access to objective, science-based sexual information that adolescents need. Unfortunately, as indicated by the Alexander et al study, primary care physicians often do not discuss sexual health with adolescents.…”