Child Neurology Fellow UPMC Children's Hospital of Pittsburgh UPMC Children's Hospital of Pittsburgh Pittsburgh, Pennsylvania, United States
Background: Adolescent and young adult (AYA) women with epilepsy have unique needs for sexual and reproductive healthcare (SRH), including counseling about folic acid, teratogenesis, and antiseizure medication-contraceptive interactions. Prior research suggests gaps in SRH care for this population.
Objective: To evaluate knowledge, attitudes, and practices about SRH for AYA women with epilepsy, including barriers and facilitators to SRH provision, among general pediatricians, adolescent medicine specialists, and pediatric gynecologists.
Design/Methods: We invited general pediatricians, adolescent medicine specialists, and pediatric gynecologists to complete an online survey through specialty listservs. We analyzed categorical variables with Chi-Square or Fisher’s exact tests, and continuous variables with Kruskal-Wallis tests. All statistical comparisons by specialty included all three specialties.
Results: Of 329 participants, 57% were general pediatricians, 27% were adolescent medicine specialists, and 16% were pediatric gynecologists. On 15 items assessing knowledge of SRH for AYA women with epilepsy, general pediatricians scored 60% correct [Interquartile Ratio (IQR) =0.5, 0.7], compared with 70% [IQR=0.6, 0.7] for adolescent medicine specialists and 70% [IQR=0.7, 0.8] for pediatric gynecologists (p<0.01). Among 11 items about confidence in SRH skills, general pediatricians were confident in 20% [IQR=0.1, 0.4] of skills compared with 80% [IQR=0.6, 0.9] for adolescent medicine specialists and 90% [IQR=0.8, 1.0] for pediatric gynecologists (p<0.01). Of 7 SRH counseling topics, general pediatricians reported that they would perform annual counseling about 60% [IQR=0.1, 1.0] of topics compared with 90% [IQR=0.4, 1.0] for adolescent medicine specialists and 70% [IQR=0.6, 1.0] for pediatric gynecologists (p<0.01). Over half (54%) reported that barriers to SRH provision include limited time during office visits and lack of knowledge of SRH and epilepsy. Respondents identified facilitators including guidelines/algorithms for managing SRH for AYA with epilepsy (83%), provider education about SRH and epilepsy (61%) and EHR alerts (60%). Conclusion(s): Survey responses suggest suboptimal knowledge, confidence, and care provision regarding SRH for AYA women with epilepsy, particularly among general pediatricians relative to adolescent medicine and pediatric gynecology. Identified barriers and facilitators may serve as targets for interventions to improve SRH care provision for this population.
Authors/Institutions: Laura Kirkpatrick, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Hui Liu, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Sonika Bhatnagar, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Terrill Bravender, University of Michigan Michigan Medicine, Ann Arbor, Michigan, United States; Elizabeth Harrison, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Traci M. Kazmerski, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Yoshimi Sogawa, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Tahniat Syed, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States; Timothy Shope, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, United States
