A Brief Look: Best Practices in Sexual and Reproductive Health Care for Adolescents
Meghna Nayak, MD
As we focus our attention this month towards our newly added adolescent clinic run by Dr. Heather Needham, what better time to review a few of the recent recommendations on adolescent health care while we continue to strive for excellence in caring for our adolescent population.
The New York City Department of Health recommends a set of core practices for providers who routinely care for the adolescent population in a primary care setting. These practices correlate with the CDC recommendations and are also endorsed by the District II, NYS chapter of the American Academy of Pediatrics.
The first recommendation of these core practices is to screen for sexual activity at every patient visit from age 12 as well as to routinely assess for mental health issues, abuse, and interpersonal violence. As providers of primary health care, we must make time to discuss prevention of STI’s and pregnancy during every available opportunity. In addition to discussing prevention we can also help by providing access to condoms, effective birth control methods, and emergency contraception.
Adherence to current guidelines also requires that primary care providers screen all sexually active females, as well as males in high-risk groups, for chlamydia and gonorrhea on an annual basis. Urine based testing for STIs can help to avoid pelvic and urethral specimen collection, thereby decreasing refusal by patients to routine screening measures.
When appropriate, New York state health care providers may provide expedited partner therapy (EPT) for treatment of chlamydia such as a prescription to a patient in the office for known sex partners in the past 60 days. EPT may not currently be provided to patients who have concurrent gonorrhea or syphilis infection.
The above guidelines may seem daunting considering our patient confidentiality obligation as well as the time restraints we all face in our daily practice. How do I explain to a mother why her daughter came in for an evaluation for fever and asthma exacerbation but is giving a urine sample after we have spoken privately?
Despite various barriers to meet these new and comprehensive screening measures, it falls to us to come up with solutions to uphold the highest quality of patient care.
Perhaps the process can start right at the front desk of our offices by requesting adolescent patients to update their confidential contact information. Obtaining a urine sample during the triage of every patient aged 12 and up prior to their visit can become as routine as checking their blood pressure, alleviating some of the stigma associated with STI screening for patients and their parents. The new guidelines call for increased screening but also focus on prevention by asking providers help our patients break the barriers to access.
Various. “Best Practices in Sexual and Reproductive Health Care for Adolescents.” www.nyc.gov. Available at: http://www.nyc.gov/html/doh/downloads/pdf/ms/adolescent-sex-best practices-online.pdf. Last accessed Dec. 27, 2012.
Various. “Expedited Partner Therapy (EPT) Guidelines for Health Care Providers in New York State for Chlamydia trachomatis.” www.nyc.gov.
Available at: http://www.nyc.gov/html/doh/downloads/pdf/std/ept-hcp-chlamydia-Trachomatis-guidelines.pdf. Last accessed Dec. 27, 2012.