Modest Impact of a Brief Curricular Intervention on Poor Documentation of Sexual History in University-Based Resident Internal Medicine Clinics

Abstract

Introduction Providers need an accurate sexual history for appropriate screening and counseling. While curricula on sexual history taking have been described, the impact of such interventions on resident physician performance of the sexual history remains unknown. Aims Our aims were to assess the rates of documentation of sexual histories, the rates of documentation of specific components of the sexual history, and the impact of a teaching intervention on this documentation by Internal Medicine residents. Methods The study design was a teaching intervention with a pre- and postintervention chart review. Participants included postgraduate years two (PGY-2) and three (PGY-3) Internal Medicine residents (N=25) at two university-based outpatient continuity clinics. Residents received an educational intervention consisting of three 30-minute, case-based sessions in the fall of 2007. Main Outcome Measures We reviewed charts from health-care maintenance visits pre- and postintervention. We analyzed within resident pre- and postrates of sexual history taking and the number of sexual history components documented using paired t-tests. Results In total, we reviewed 369 pre- and 260 postintervention charts. The mean number of charts per resident was 14.8 (range 8–29) pre-intervention and 10.4 (range 3–25) postintervention. The mean documentation rate per resident for one or more components of sexual history pre- and postintervention were 22.5% (standard deviation [SD]=18.1%) and 31.7% (SD=20.4%), respectively, P <0.01. The most frequently documented components of sexual history were current sexual activity, number of current sexual partners, and gender of current sexual partner. The least documented components were history of specific sexually transmitted infections, gender of sexual partners over lifetime, and sexual behaviors. Conclusion An educational intervention modestly improved documentation of sexual histories by Internal Medicine residents. Future studies should examine the effects of more comprehensive educational interventions and the impact of such interventions on physician behavior or patient care outcomes.

Patient, Resident Physician, and Visit Factors Associated with Documentation of Sexual History in the Outpatient Setting

“…19,20 The extraction tool consisted of 18 components including current and past sexual activity, number of sexual partners, gender of current sexual partner, and history of STIs. 2 We hypothesized that younger patient age, resident-patient gender concordance, visits for Papanicolaou test, and genitourinary or STI concerns would be associated with a documented sexual history. Resident and patient demographic factors were analyzed as categorical variables (patient age was ordinal in 10-year categories, gender was dichotomous, and marital status was in six categories).…”

“…2 We therefore, sought to better understand the patient, physician, and visit factors that were associated with documentation of a sexual history in the hopes of identifying better strategies to address this quality of care issue.…”

“…1 In 1996, the United States Preventive Services Task Force (USPSTF) recommended risk reduction counseling, family planning, and contraception for all adolescents and adults. 2 Since then, national and international guidelines have recommended routine sexual risk assessment to inform STI testing and counseling decisions. 3,4 The USPSTF, Centers for Disease Control and Prevention (CDC), American Academy of Family Physicians, and American College of Obstetricians and Gynecologists all recommend that the need and frequency of testing for chlamydia, gonorrhea, human immunodeficiency virus (HIV), and syphilis should be based on behavioral and demographic risk factors.…”

“…11 Two studies that assessed internal medicine resident sexual historytaking behaviors through chart review or standardized patients reported frequencies similar to those reported by patients. 2,12 Educational interventions have produced only modest improvement in self-reported frequencies of sexual history-taking. 2,13,14 Sexual history-taking is a challenging communication subject.…”

“…2,12 Educational interventions have produced only modest improvement in self-reported frequencies of sexual history-taking. 2,13,14 Sexual history-taking is a challenging communication subject. Understanding patient and provider variables associated with sexual history documentation can highlight future quality improvement targets.…”