Testing for Chlamydia and Sexual History Taking in Adolescent Females: Results From a Statewide Survey of Colorado Primary Care Providers

Abstract

ABSTRACT. Objectives. Little is known about the practice patterns of primary care providers as they relate to assessing risk of and screening for chlamydial infections, an important cause of preventable reproductive morbidity in young women in the United States. The present cross-sectional study was undertaken to assess levels of chlamydia testing, sexual history taking, and prevention practices by Colorado primary care physicians, nurse practitioners, and physician assistants who provide gynecologic care to adolescent females (13-19 years old).Methods. Between July 1998 and October 1998, an anonymous, self-administered questionnaire was mailed to a 25% random sample (n ‫؍‬ 1265) of Colorado physicians (family practitioners, internal medicine specialists, obstetrician-gynecologists, and pediatricians), nurse practitioners, and physician assistants. Practitioners were identified through professional organization membership, state-licensing bodies, and listings in the yellow pages.Results. After estimating the eligibility rate among nonrespondents, the adjusted response rate was 71.5%. Only 53.8% of providers reported regularly testing sexually active female adolescents for chlamydia; 71.8% of providers regularly took a sexual history. Female providers reported significantly higher levels of regularly taking a sexual history (87.2% vs 60.6% of males), feeling comfortable discussing sex (94.4% vs 77.8%), discussing sexually transmitted disease (STD) prevention (81.5% vs 71.3%), and testing for chlamydia (64.4% vs 38.6%). Among provider types, obstetrician-gynecologists, nurse practitioners, and pediatricians were most likely to report regularly taking a sexual history (90.1%, 88.6%, and 76.0%, respectively). Internal medicine specialists were the least likely to report taking a sexual history (43.9%). Pediatricians and nurse practitioners were the most likely to report testing sexually active adolescent females for chlamydia (74.1% and 70.1%, respectively), whereas physician assistants and internal medicine specialists were the least likely (46.0% and 38.5%, respectively).In multivariate analysis, variables independently associated with regularly taking a sexual history included female provider gender (odds ratio [OR]: 5.5; 95% confidence interval [CI]: 2.9 -10.9), obstetrics/gynecology specialty (OR: 4.0; 95% CI: 1.7-10.3; referent group: family practitioners), and provider comfort level in discussing sex (OR: 4.9; 95% CI: 2.3-11

The impact of discussing a sexual history in role-play simulation teaching on pre-clinical student attitudes towards people who submit for STI testing

“…Elements of both impact on people's physical and mental health at many levels (Department of Health 2001), and have clinical importance in other areas (Torkko et al 2000). GUM patients might expect to be asked intimate questions, whereas in a GP consultation asking the 'out of the blue' question about a person's sexual activity is important, but may be less expected (Matthews et al 1997), and hence less well received.…”

Chlamydia Screening and Management Practices of Primary Care Physicians and Nurse Practitioners in California

“…The rate in California appears higher than some national physician estimates, 7 but lower than the self-reported screening rate found among primary care physician and nurse practitioners in Colorado. 23 Independent predictors of screening practices identified in this study will be helpful in targeting outreach and education to primary care providers to improve screening rates. For example, internists, family practitioners, general practitioners, and nurse practitioners in private practice settings may benefit from continuing professional education.…”

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

“…While 72% of Colorado clinicians recently reported regularly taking a sexual history with female adolescents [12], 40% of California clinicians reporting taking a sexual history of all their adolescent patients [13]. A retrospective chart review of newly identified HIV infected adult patients revealed that, of those with a prior medical care encounter, all had chart notation indicating a missed trigger for HIV testing [14].…”

“…Clinician lack of STD training and beliefs that they: can effectively prevent STD, are responsible for STD prevention services, can provide routine STD screening that is costeffective, have clarity regarding adolescent confidentiality, have adequate time and receive adequate reimbursement are all barriers to addressing STD prevention in primary care [12,19,[20][21][22][23]. Adolescents' lack of psychosocial maturity, confidence in their confidentiality, feelings of self-esteem, perceived susceptibility, familiarity with the clinician, and positive attitudes toward discussing sexuality with the clinician are barriers to discussing STD prevention with the clinician [18,24].…”