title: Pilot study of reproductive health counseling in a pediatric rheumatology clinic.
abstract: Objective: To assess perception and behavior after reproductive health counseling among adolescent patients in a tertiary care-based pediatric rheumatology clinic. Methods: Adolescent females seen at Stanford pediatric rheumatology clinic were prospectively enrolled during routine visits. At study start, standard clinic procedures for the following were reviewed with providers: 1) HEADSS (home, education, activities, drugs, sexual activity, and suicide/depression) assessment; 2) reproductive health counseling; and 3) medical record documentation. Patients were enrolled if providers indicated that they performed HEADSS assessment and reproductive health counseling. At enrollment, patients completed a survey to assess perceptions of reproductive health counseling. Chart review confirmed documented discussions. Follow-up survey 3-5 months after enrollment tracked reproductive health information seeking behavior. Results: Ninety females (ages 17 ± 2 years old) participated. Almost all patients (99%) agreed that reproductive health was discussed. Seventy-one percent reported that pregnancy risks were discussed, 42% had recent concerns about reproductive health, and 33% reported their provider recommended that they seek further reproductive health care. Eighty-four patients completed follow-up phone surveys, with 25% reporting seeking further information on reproductive health concerns but merely 9.5% actually sought further care. Only 18% reported having ever asked their rheumatology provider for guidance regarding reproductive health care concerns. Conclusion: Routine reproductive health discussion and counseling are necessary in a rheumatology clinic; as in our experience, a substantial number of adolescents have concerns and actively seek reproductive health information. Despite these discussions, teens rarely pursued further reproductive health care. Further work to bridge this gap is needed.
authors.affiliation: George Washington University School of Medicine and Health Sciences, Washington, DC, USA.  tronis@cnmc.org
authors.forename: Tova
authors.initials: T
authors.lastname: Ronis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frankovich
authors.forename: Sophia
authors.initials: S
authors.lastname: Yen
authors.forename: Christy
authors.initials: C
authors.lastname: Sandborg
authors.forename: Peter
authors.initials: P
authors.lastname: Chira
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D000554:Ambulatory Care Facilities; D003376:Counseling; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006306:Health Surveys; D006801:Humans; D057226:Information Seeking Behavior; D010865:Pilot Projects; D060728:Reproductive Health; D012216:Rheumatic Diseases; D012219:Rheumatology; D055815:Young Adult
references.citation: MMWR Morb Mortal Wkly Rep. 2013 Jan 4;61(51-52):1038-42
references.pmid: 23282861
references.citation: J Adolesc Health. 1998 Dec;23(6):344-53
references.pmid: 9870328
references.citation: Arch Fam Med. 1994 Feb;3(2):125-8; discussion 129
references.pmid: 7994433
references.citation: Arthritis Care Res (Hoboken). 2011 Jan;63(1):10-6
references.pmid: 20842714
references.citation: Arch Pediatr Adolesc Med. 2000 May;154(5):478-83
references.pmid: 10807299
references.citation: Birth Defects Res A Clin Mol Teratol. 2010 Jan;88(1):64-9
references.pmid: 19637252
references.citation: MMWR Surveill Summ. 2009 Jul 17;58(6):1-58
references.pmid: 19609250
references.citation: Semin Perinatol. 2007 Aug;31(4):223-6
references.pmid: 17825677
references.citation: Lupus. 2007;16(8):606-12
references.pmid: 17711896
references.citation: MMWR Morb Mortal Wkly Rep. 2012 Jan 20;61(2):25-9
references.pmid: 22258415
references.citation: Arch Dis Child. 2010 Sep;95(9):717-23
references.pmid: 20522463