Delivery of STD/HIV preventive services to adolescents by primary care physicians

Purpose: To document the rates of STD/HIV preventive services delivered to adolescents by primary care physicians in California, and to identify variation owing to physician and practice-related factors. Methods: A stratified random sample of California internists, family physicians, obstetrician-gynecologists, and pediatricians was drawn from the AMA Masterfile and surveyed by mail about their practices with regard to STD/HIV prevention for 15-18-year-old adolescent patients. Sixty percent of eligible physicians responded; the final sample was 1217 physicians. Results: Results showed that 40% of physicians reported screening all of their adolescent patients for sexual activity and 31% reported educating all of their adolescent patients about STD/HIV transmission. For their sexually active adolescent patients, 36% of physicians always provided STD/HIV education, 17% always screened for number of previous sexual partners; 12% always screened for sexual orientation; and 10% always screened for frequency of casual sex. Four percent of the physicians reported that they always provided condoms for their sexually active adolescent patients; 81% never provided condoms. Higher levels of preventive services delivery were associated with female physician gender, specialization in obstetrics-gynecology, and more recent date of medical school graduation. Physicians practicing in health maintenance organizations reported providing significantly higher rates of preventive services to sexually active adolescents than did physicians in private practice. Conclusions: Primary care physicians provide STD/HIV preventive services to adolescents at rates far below those recommended by current guidelines. Areas where additional research would be informative are highlighted.