Improving rheumatologists' screening for alcohol use and sexual activity.
OBJECTIVE
To design, implement, and assess the impact of an office-based intervention designed to improve rheumatologists' identification of risk behaviors, especially alcohol use and sexual activity, among adolescents and young adults with chronic rheumatologic conditions.


METHODS
Prospective intervention study.


METHODS
Midwestern academic pediatric rheumatology practice.


METHODS
Ten attending rheumatologists and fellows and 178 patients (mean age, 18.1 years; 67% female; 88% white; 69% with juvenile rheumatoid arthritis) seen in the practice during the baseline and intervention years.


METHODS
Change in the rate of screening for alcohol use and sexual activity from the baseline to the intervention year, and physician perceptions of the intervention.


RESULTS
Screening for alcohol use increased from 4.2% (9/208) at baseline to 31.6% (56/177) after the intervention (P<.001). Of those patients undergoing screening at follow-up, 20 (36%) of 56 patients reported any alcohol use and 11 (20%) reported current alcohol use. Of those reporting current use, 7 (64%) were counseled or referred. Methotrexate use increased the likelihood of alcohol screening (43% [33/76] vs 26% 123/871; P = .02). Screening for sexual activity increased from 12.4% (27/ 218) to 36.2% (64/177) (P<.001) from baseline to follow-up. Of 52 females undergoing screening at follow-up, 31 (60%) were sexually active. Eleven (41%) of 27 sexually active females were not using contraception other than condoms (4 were not asked about contraception); 7 (82%) of these were referred for contraceptive counseling. Seven rheumatologists completed in-depth semistructured interviews after the intervention. All reported time as a main barrier to screening. Other barriers included logistical problems, discomfort with the subject area, ambivalence about whether risk behavior screening is the province of pediatric rheumatologists, and perceived lack of applicability to their patients.


CONCLUSIONS
Despite knowledge and concern about the interaction of immunosuppressive therapy and risk behaviors, few rheumatologists adequately screen the behavior of their adolescent and young adult patients. Time constraints, organizational issues, and physician beliefs remain barriers to widespread screening.
Britto
M T
MT
Institute for Health Policy and Health Services Research, Department of Pediatrics, The Children's Hospital Medical Center, University of Cincinnati, Ohio 45229-3039, USA. maria.britto@chmcc.org
Rosenthal
S L
SL
Taylor
J
J
Passo
M H
MH
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D000704:Analysis of Variance; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D016015:Logistic Models; D008297:Male; D015146:Midwestern United States; D010818:Practice Patterns, Physicians'; D011314:Preventive Health Services; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000175:diagnosis / Q000188:drug therapy; D012309:Risk-Taking; D012725:Sexual Behavior