Student University of Maryland School of Medicine Baltimore, Maryland, United States
Background: Adolescent sexual health documentation reflects the depth of discussion physicians conduct with their patients, but limited studies exist on rates of sexual history documentation in technology dependent patients compared to that in non-technology dependent pediatric patients. Some evidence suggests lower rates of documentation of sexual history or contraception use in this population. This is problematic given that patients with physical disabilities and chronic conditions engage in sexual activity at the same rate as those without these diagnoses. Objective: We sought to identify if treatment gaps exist in a technology dependent adolescent population via review of documentation of sexual history and anticipatory guidance. We compared rates of sexual history documentation for patients with enterotomy or tracheostomy dependence, in comparison to their non-technology dependent peers. Design/Methods: Retrospective chart review was conducted of all well-child visits for patients meeting technology-dependent criteria, aged 12-19 years, and seen in our urban, academic clinic over the prior three-year period (n=14) and compared with age-matched, randomly selected peers without technology dependence. Presence of documentation was noted in the areas of sexual activity, sexual orientation, safe sex and STI guidance, and contraception or condom use. Results: Results demonstrate lower rates of documentation of sexual orientation (p= 0.0091), safe sex and STI guidance (p=0.023), and contraception or condom use (0.00091) in patients with technology dependence when compared to patients without technology dependence. No differences were found in documentation of sexual activity (12/14 patients had sexual activity documented in both groups and p >0.5 in all categories). In the older age group (16-19 years), differences were found with decreased documentation in the experimental group on sexual orientation (p=0.0044), safe sex and STI guidance (p=0.018), and contraception or condom use (0.0044).
Conclusion(s): Discussions of sexual health during well-child visits lead to better outcomes in terms of practicing safe sex and STI guidance or pregnancy prevention. Future studies should explore if documentation gaps affect sexual health outcomes in technology-dependent adolescents.