Quality of Sexual and Reproductive Health Services for Adolescents: Findings from A Survey of U.S. Physicians

ABSTRACT

Purpose: Quality sexual and reproductive health (SRH) care for adolescents includes implementation of youth-friendly clinical practices (e.g., practices that support minor’s rights to confidential care) and provision of recommended clinical services (e.g., access to the full range of contraceptive methods). There is limited data from providers regarding the quality of SRH care for adolescents in the United States. This analysis examines physician-reported prevalence of youth-friendly practices and SRH services overall and by physician specialty to inform focused improvement efforts. Methods: Data were from the DocStyles online panel survey administered with U.S. healthcare providers September-October 2020. The survey assessed whether the following youth-friendly practices were in place just before the COVID-19 pandemic walk-in hours, evening/weekend hours, time alone with a provider at every visit, confidentiality policy communicated at every visit, and routine encouragement of parent-adolescent communication. SRH services assessed included long-acting reversible contraception (LARC) insertion and removal, clinic-based sexually transmitted infection (STI) testing, and counseling about STI prevention at contraception initiation. We restricted the analytic sample to family practitioners (n=364), internists (n=247), pediatricians (n=180), and obstetricians/gynecologists (n=213) primarily working in outpatient settings who reported providing family planning or STI services to at least one patient aged 15-19 years per week just before the pandemic. Descriptive statistics were calculated overall and for each physician specialty, and chi-squared tests were used to examine differences. We also explored associations between physician-report of adolescent SRH quality improvement (QI) efforts in the year just before the pandemic and each youth-friendly practice and SRH service. Generalized linear models were used to produce adjusted prevalence ratios (APR) controlling for physician specialty, individual versus group practice, and adolescent patient volume for SRH services. Results: Among physicians who provided SRH services to adolescents overall, the proportion with youth-friendly practices in place ranged from 44.7% for weekend/evening hours available to 60.5% for routine encouragement of parent-adolescent communication. Walk-in hours and evening/weekend hours available were highest for pediatricians and lowest for obstetricians/gynecologists. Nearly three-quarters of pediatricians and obstetricians/gynecologists reported always providing time alone and communicating the confidentiality policy whereas only about half of family physicians and one-third of internists reported each of these practices. Overall, 37.6% reported their practice provided LARC placement and removal, 79.3% provided clinic-based STI testing, and 66.3% always discussed STI prevention with adolescents initiating contraception. Across these services, prevalence was consistently highest for obstetricians/gynecologists and lowest for internists, although the proportion of internists and pediatricians providing LARC services was similarly low (12.2% and 13.3%, respectively). Overall, about one-quarter (28.5%) of physicians reported that adolescent SRH QI efforts were conducted in the past year, and QI was associated with increased likelihood of having youth-friendly practices in place and providing SRH services for all indicators except weekend/evening hours and LARC services (APR range 1.10-1.55). Conclusions: Findings suggest opportunities to improve youth-friendly practices and delivery of SRH services for adolescents, which vary by physician specialty. Implementing adolescent-focused SRH QI initiatives may be one approach to strengthening certain youth-friendly practices and clinical services. Sources of Support None.