Objectives: To design, implement, and assess the impact of an office-based
intervention designed to improve rheumatologists' identification of risk be
haviors, especially alcohol use and sexual activity, among adolescents and
young adults with chronic rheumatologic conditions.
Design: Prospective intervention study.
Setting: Midwestern academic pediatric rheumatology practice.
Participants: Ten attending rheumatologists and fellows and 178 patients (m
ean age, 18.1 years; 67% female: 88% white; 69% with juvenile rheumatoid ar
thritis) seen in the practice during the baseline and intervention years.
Main Outcome Measures: Change in the rate of screening for alcohol use and
sexual activity from the baseline to the intervention year, and physician p
erceptions of the intervention.
Results: Screening for alcohol use increased from 4.2% (9/208) at baseline
to 31.6% (56/177) after the intervention (P<.001). Of those patients underg
oing screening at follow-up, 20 (36%) of 56 patients reported any alcohol u
se and 11 (20%) reported current alcohol use. Of those reporting current us
e, 7 (64%) were counseled or referred. Methotrexate use increased the likel
ihood of alcohol screening (43% [33/76] vs 26% [23/87]; P = .02). Screening
for sexual activity increased from 12.4% (27/218) to 36.2% (64/177) (P<.00
1) from baseline to follow-up up. Of 51 females undergoing screening at fol
low-up, 31 (60%) were sexually active. Eleven (41%) of 27 sexually active f
emales were not using contraception other than condoms (4 were not asked ab
out contraceptive counseling. Seven of these were referred for contraceptiv
e counseling. Seven rheumatologists completed in-depth semistructured inter
views after the intervention. All reported time as a main barrier to screen
ing. Other barriers included logistical problems, discomfort with the subje
ct area, ambivalence about whether risk behavior screening is the province
of pediatric rheumatologists. and perceived lack of applicability to their
patients.
Conclusions: Despite knowledge and concern about the interaction of immunos
uppressive therapy and risk behaviors, Few rheumatologists adequately scree
n the behavior of their adolescent and young adult patients. Time constrain
ts, organizational issues, and physician beliefs remain barriers to widespr
ead screening.