Patient and Clinician Sociodemographics and Sexual History Screening at a Multisite Federally Qualified Health Center: A Mixed Methods Study

被引:3
作者
Gagnon, Kelly W. [1 ,4 ]
Coulter, Robert W. S. [2 ]
Egan, James E. [2 ]
Ho, Ken [3 ]
Hawk, Mary [2 ]
机构
[1] Univ Alabama Birmingham, Sch Med, Div Infect Dis, Birmingham, AL USA
[2] Univ Pittsburgh, Sch Publ Hlth, Behav & Community Hlth Sci, Pittsburgh, PA USA
[3] Univ Pittsburgh, Sch Med, Dept Med, Pittsburgh, PA USA
[4] Univ Alabama Birmingham, Heersink Sch Med, Dept Med, Div Infect Dis, 1670 Univ Blvd, Birmingham, AL 35233 USA
基金
美国国家卫生研究院;
关键词
primary care; sexual health; sexually transmitted infections; medical history taking; preventive care; preventive health services; screening; physician-patient relations; ethnic and racial minorities; vulnerable populations; medically underserved area; health care disparities; semistructured interview; mixed methods; health services research; CARE; PHYSICIANS; SERVICES; QUALITY; DELIVERY; BIAS;
D O I
10.1370/afm.3012
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
PURPOSE In 2018, there were 68 million sexually transmitted infections in the United States. Sexual history screening is an evidence-based practice endorsed by guidelines to identify risk of these infections and adverse sexual health outcomes. In this mixed methods study, we investigated patient-and clinician-level characteristics associated with receipt of sexual history screening, and contextualized these differences in more depth. METHODS We collected sociodemographics of patients from the electronic health record and sociodemographics of their primary care clinicians via a census survey. Semistructured interviews were conducted with key practice staff. We conducted multilevel crossed random effects logistic regression analysis and thematic analysis on quantitative and qualitative data, respectively. RESULTS A total of 53,246 patients and 56 clinicians from 13 clinical sites participated. Less than one-half (42.4%) of the patients had any sexual history screening documented in their health record. Patients had significantly higher odds of documented screening if they were gay or lesbian (OR = 1.23), were cisgender women (OR = 1.10), or had clinicians who were cisgender women (OR = 1.80). Conversely, patients' odds of documented screening fell significantly with age (OR per year = 0.99) and with the number of patients their clinicians had on their panels (OR per patient = 0.99), and their odds were significantly lower if their primary language was not English (OR = 0.91). In interviews, key staff expressed discomfort discussing sexual health and noted assumptions about patients who are older, in long-term relationships, or from other cultures. Discordance of patient-clinician gender and patients' sexual orientation were also noted as barriers. CONCLUSIONS Interventions are needed to address the interplay between the social and contextual factors identified in this study, especially those that elicited discomfort, and the implementation of sexual history screening.
引用
收藏
页码:395 / 402
页数:8
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