Study investigates patient- and clinician-level characteristics associated with sexual history screening

Researchers conducted a mixed methods study that investigated patient- and clinician-level characteristics associated with a sexual history screening (SHS). Participants included 53,246 patients and 56 clinicians from 13 clinical sites. Less than half (42.41%) of patients had any SHS documentation. Gay and lesbian patients; patients who were cisgender women; and patients whose doctors were cisgender women had significantly higher odds of having any SHS documented in their medical chart. Conversely, older patients; patients whose doctors have more patients on their panel; and patients whose primary language was not English had significantly lower odds of SHS documentation. During interviews, participants expressed discomfort discussing sexual health and assumptions about older patients; patients in long-term relationships; and patients from other cultures. Discordance of patient-clinician gender and patients' sexual orientation were also pertinent factors. The authors argue that programmatic efforts should address the interplay between the identified social and contextual factors, especially those that elicited discomfort, and the implementation of sexual history screening.

What we know: Sexually transmitted infections (STIs) rates have consistently increased over time, with a preliminary estimate of 2.5 million cases in 2021. Sexual history screening (SHS) is an evidence-based medical guideline to identify risk of STIs (including HIV), and adverse sexual health outcomes. Primary care settings are an important environment for universal SHS, as patients predominantly report seeking STI care from their primary care physicians (PCP). Primary care clinics also diagnose approximately half of all reported STIs annually.

What this study adds: Among a pool of 53,246 adult patients, less than half had any sexual history documented in their medical charts (42.41%). Study findings demonstrate key sociodemographics associated with the likelihood of implementing SHS, building on both data from the medical record and from the perspective of PCPs. This study underscores the importance of patient-physician relationships, sociodemographics, and SHS. It also indicates the existence of an interplay between social and contextual factors and the implementation of SHS as part of routine clinical care.


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