Journal of General Internal Medicine

, Volume 26, Issue 8, pp 887–893 | Cite as

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

  • Danielle F. Loeb
  • Rita S. Lee
  • Ingrid A. Binswanger
  • Misoo C. Ellison
  • Eva M. Aagaard
Original Research

ABSTRACT

BACKGROUND

Providers need an accurate sexual history for appropriate screening and counseling, but data on the patient, visit, and physician factors associated with sexual history-taking are limited.

OBJECTIVES

To assess patient, resident physician, and visit factors associated with documentation of a sexual history at health care maintenance (HCM) visits.

DESIGN

Retrospective cross-sectional chart review.

PARTICIPANTS

Review of all HCM clinic notes (n = 360) by 26 internal medicine residents from February to August of 2007 at two university-based outpatient clinics.

MEASUREMENTS

Documentation of sexual history and patient, resident, and visit factors were abstracted using structured tools. We employed a generalized estimating equations method to control for correlation between patients within residents. We performed multivariate analysis of the factors significantly associated with the outcome of documentation of at least one component of a sexual history.

KEY RESULTS

Among 360 charts reviewed, 25% documented at least one component of a sexual history with a mean percent by resident of 23% (SD = 18%). Factors positively associated with documentation were: concern about sexually transmitted infection (referent: no concern; OR = 4.2 [95% CI = 1.3–13.2]); genitourinary or abdominal complaint (referent: no complaint; OR = 4.3 [2.2–8.5]); performance of other HCM (referent: no HCM performed; OR = 3.2 [1.5–7.0]), and birth control use (referent: no birth control; OR = 3.0 [1.1, 7.8]). Factors negatively associated with documentation were: age groups 46–55, 56–65, and >65 (referent: 18–25; ORs = 0.1, 0.1, and 0.2 [0.0–0.6, 0.0–0.4, and 0.1–0.6]), and no specified marital status (referent: married; OR = 0.5 [0.3–0.8]).

CONCLUSIONS

Our findings highlight the need for an emphasis on documentation of a sexual history by internal medicine residents during routine HCM visits, especially in older and asymptomatic patients, to ensure adequate screening and counseling.

KEY WORDS

communication skills medical education aging sexually transmitted disease ambulatory care 

References

  1. 1.
    Education and treatment in human sexuality: the training of health professionals. Report of a WHO meeting. World Health Organ Tech Rep Ser. 1975;(572):5–33.Google Scholar
  2. 2.
    Loeb DF, Aagaard EM, Cali SR, Lee RS. Modest impact of a brief curricular intervention on poor documentation of sexual history in university-based resident internal medicine clinics. J Sex Med. Jun 17 2010.Google Scholar
  3. 3.
    United States. Agency for Healthcare Research and Quality., US Preventive Services Task Force. Guide to clinical preventive services, 2005: recommendations of the US Preventive Services Task Force. [Washington, DC]: Agency for Healthcare Research and Quality; 2005.Google Scholar
  4. 4.
    Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep. 2006;55(RR-11):1–94.PubMedGoogle Scholar
  5. 5.
    Meyers D, Wolff T, Gregory K, et al. USPSTF recommendations for STI screening. Am Fam Physician. 2008;77(6):819–824.PubMedGoogle Scholar
  6. 6.
    Boulware LEBG, Wilson RF, Phillips K, Maynor K, Hwang C, Marinopoulos S, Merenstein DR-MP, Bass EB, Powe NR, Daumit GL. Value of the Periodic Health Evaluation. Evidence Report/Technology Assessment No. 136. (Prepared by The Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018). Rockville, MD:2006.Google Scholar
  7. 7.
    Boekeloo BO, Marx ES, Kral AH, Coughlin SC, Bowman M, Rabin DL. Frequency and thoroughness of STD/HIV risk assessment by physicians in a high-risk metropolitan area. Am J Public Health. 1991;81(12):1645–1648.PubMedCrossRefGoogle Scholar
  8. 8.
    Lewis CE, Freeman HE. The sexual history-taking and counseling practices of primary care physicians. West J Med. 1987;147(2):165–167.PubMedGoogle Scholar
  9. 9.
    Platano G, Margraf J, Alder J, Bitzer J. Frequency and focus of sexual history taking in male patients–a pilot study conducted among Swiss general practitioners and urologists. J Sex Med. 2008;5(1):47–59.PubMedCrossRefGoogle Scholar
  10. 10.
    Wimberly YH, Hogben M, Moore-Ruffin J, Moore SE, Fry-Johnson Y. Sexual history-taking among primary care physicians. J Natl Med Assoc. 2006;98(12):1924–1929.PubMedGoogle Scholar
  11. 11.
    Tao G, Irwin KL, Kassler WJ. Missed opportunities to assess sexually transmitted diseases in US adults during routine medical checkups. Am J Prev Med. 2000;18(2):109–114.PubMedCrossRefGoogle Scholar
  12. 12.
    Curtis JR, Paauw DS, Wenrich MD, Carline JD, Ramsey PG. Internal medicine residents’ skills at identification of HIV-risk behavior and HIV-related disease. Acad Med. 1994;69(10 Suppl):S45–S47.PubMedCrossRefGoogle Scholar
  13. 13.
    Ross PE, Landis SE. Development and evaluation of a sexual history-taking curriculum for first- and second-year family practice residents. Fam Med. 1994;26(5):293–298.PubMedGoogle Scholar
  14. 14.
    Rosen R, Kountz D, Post-Zwicker T, Leiblum S, Wiegel M. Sexual communication skills in residency training: the Robert Wood Johnson model. J Sex Med. 2006;3(1):37–46.PubMedCrossRefGoogle Scholar
  15. 15.
    Temple-Smith M, Hammond J, Pyett P, Presswell N. Barriers to sexual history taking in general practice. Aust Fam Physician. 1996;25(9 Suppl 2):S71–S74.PubMedGoogle Scholar
  16. 16.
    Verhoeven V, Bovijn K, Helder A, et al. Discussing STIs: doctors are from Mars, patients from Venus. Fam Pract. 2003;20(1):11–15.PubMedCrossRefGoogle Scholar
  17. 17.
    Burd ID, Nevadunsky N, Bachmann G. Impact of physician gender on sexual history taking in a multispecialty practice. J Sex Med. 2006;3(2):194–200.PubMedCrossRefGoogle Scholar
  18. 18.
    Maheux B, Haley N, Rivard M, Gervais A. Do women physicians do more STD prevention than men? Quebec study of recently trained family physicians. Can Fam Physician. 1997;43:1089–1095.PubMedGoogle Scholar
  19. 19.
    Powderly WG, Mayer KH. Centers for Disease Control and Prevention revised guidelines for human immunodeficiency virus (HIV) counseling, testing, and referral: targeting HIV specialists. Clin Infect Dis. 2003;37(6):813–819.PubMedCrossRefGoogle Scholar
  20. 20.
    Haist SA, Griffith IC, Hoellein AR, Talente G, Montgomery T, Wilson JF. Improving students’ sexual history inquiry and HIV counseling with an interactive workshop using standardized patients. J Gen Intern Med. 2004;19(5 Pt 2):549–553.PubMedCrossRefGoogle Scholar
  21. 21.
    Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42(1):121–130.PubMedCrossRefGoogle Scholar
  22. 22.
    O’Keefe R, Tesar CM. Sex talk: what makes it hard to learn sexual history taking? Fam Med. 1999;31(5):315–316.PubMedGoogle Scholar
  23. 23.
    Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. N Engl J Med. 2007;357(8):762–774.PubMedCrossRefGoogle Scholar
  24. 24.
    Bachmann GA, Leiblum SR, Grill J. Brief sexual inquiry in gynecologic practice. Obstet Gynecol. 1989;73(3 Pt 1):425–427.PubMedGoogle Scholar
  25. 25.
    HIV Surveillance Report, 2008. Centers for Disease Control and Prevention; 2010.Google Scholar
  26. 26.
    St Lawrence JS, Montano DE, Kasprzyk D, Phillips WR, Armstrong K, Leichliter JS. STD screening, testing, case reporting, and clinical and partner notification practices: a national survey of US physicians. Am J Public Health. 2002;92(11):1784–1788.PubMedCrossRefGoogle Scholar
  27. 27.
    Tsimtsiou Z, Hatzimouratidis K, Nakopoulou E, Kyrana E, Salpigidis G, Hatzichristou D. Predictors of physicians’ involvement in addressing sexual health issues. J Sex Med. 2006;3(4):583–588.PubMedCrossRefGoogle Scholar
  28. 28.
    Shindel AW, Ando KA, Nelson CJ, Breyer BN, Lue TF, Smith JF. Medical student sexuality: how sexual experience and sexuality training impact US and Canadian medical students’ comfort in dealing with patients’ sexuality in clinical practice. Acad Med. 2010;85(8):1321–1330.PubMedCrossRefGoogle Scholar
  29. 29.
    Goulet F, Jacques A, Gagnon R, Racette P, Sieber W. Assessment of family physicians’ performance using patient charts: interrater reliability and concordance with chart-stimulated recall interview. Eval Health Prof. 2007;30(4):376–392.PubMedCrossRefGoogle Scholar
  30. 30.
    Chisholm CD, Weaver CS, Whenmouth LF, Giles B, Brizendine EJ. A comparison of observed versus documented physician assessment and treatment of pain: the physician record does not reflect the reality. Ann Emerg Med. 2008;52(4):383–389.PubMedCrossRefGoogle Scholar
  31. 31.
    Adams AS, Soumerai SB, Lomas J, Ross-Degnan D. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care. 1999;11(3):187–192.PubMedCrossRefGoogle Scholar
  32. 32.
    Gordon NP, Hiatt RA, Lampert DI. Concordance of self-reported data and medical record audit for six cancer screening procedures. J Natl Cancer Inst. 1993;85(7):566–570.PubMedCrossRefGoogle Scholar
  33. 33.
    Holmboe ES, Hawkins RE. Methods for evaluating the clinical competence of residents in internal medicine: a review. Ann Intern Med. 1998;129(1):42–48.PubMedGoogle Scholar
  34. 34.
    Gruber T, Sharma A, Daneschvar H, Estfan B. The Hawthorne effect in the assessment of pain by house staff. Am J Hosp Palliat Care. 2003;20(3):231–234.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Danielle F. Loeb
    • 1
  • Rita S. Lee
    • 1
  • Ingrid A. Binswanger
    • 1
    • 2
    • 3
  • Misoo C. Ellison
    • 4
  • Eva M. Aagaard
    • 1
  1. 1.Division of General Internal Medicine, Department of MedicineUniversity of ColoradoAuroraUSA
  2. 2.Division of Substance DependenceUniversity of ColoradoAuroraUSA
  3. 3.Denver Health and Hospital AuthorityDenverUSA
  4. 4.School of Public HealthUniversity of Colorado DenverAuroraUSA

Personalised recommendations