Provider Adherence to Adolescent Sexual Behavior Risk Reduction Assessment Guidelines
Repository Posting Date2017-12-14T19:56:06Z
Author DetailsNicole Sovey, DNP, WHNP-BC
Lead Author Sigma AffliationNon-member
Level of EvidenceN/A
Purpose: Sexual behavior assessment and human papillomavirus (HPV) vaccination reduce sexually transmitted infections (STIs) and pregnancy risk in adolescents’. The purpose of this study was to identify performance gaps in provider compliance with established ACOG and CDC guidelines regarding HPV vaccination uptake and sexual behavior risk evaluation guidelines. Study results provide quality improvement measures for early adolescent gynecological visits for providers and healthcare systems.
Summary: A retrospective chart review was conducted on adolescent patients between 13-19 years of age, who initiated care at an outpatient women’s health clinic located in a rural Midwestern community. A self-developed data collection form incorporating elements of the CDC metrics of evidence-based guidelines for sexual history taking and HPV vaccination screening was used for the chart review. Measurement variables included provider evaluation of the following: HPV vaccination status, HPV vaccine recommendation and initiation if unvaccinated, and evaluation of sexual activity when appropriate including the 5 P components (partners, practices, prevention, protection, past history).
Outcomes: The mean age of adolescent patients to enter the clinic and establish care was 16. In the study 69% were evaluated for the HPV vaccination, fewer than 40% had received the vaccine, less than 30% were then recommended for the vaccine, and 15% initiated the vaccination series. Over half were found to be sexually active, however, there were inconsistencies in the assessment of specific quality measures. Frequency for provider evaluation of birth control use was 63.8%, condom use 40.6%, number of partners 21.7%, type of sexual practices 2.9%, and history of STIs 20.3%.
Implications: Unintended teenage pregnancy along with sexually transmitted infections (STIs) is a major public health concern. Advanced practice nurses working with adolescent populations can optimize assessment and evaluation approaches for sexual behavior risk reduction. Identifying risky adolescent sexual behavior and reviewing HPV vaccine uptake at initial gynecologic exams can considerably improve health outcomes. Assessing adherence to current practice guidelines on these two representative variables during adolescent reproductive health visits is the first step to achieving improved outcomes.