EXECUTIVE SUMMARY

Results from a recent study of U.S. teens ages 13-19 show that when they are diagnosed and prescribed antibiotics for sexually transmitted infections (STIs) during ED visits, some 60% fail to fill the prescriptions.

• The findings are a concern for providers, since adolescents represent nearly half of all diagnosed STIs annually. More than 1.7 million cases of chlamydia were diagnosed in 2017, with 45% of cases found among young females ages 15 to 24.
• Recent research indicates that one of every eight sexually experienced teenagers and young adults on their parents’ health insurance plan said they would not seek out sexual or reproductive healthcare advice because their parents might find out.

Results from a recent study of U.S. teens ages 13-19 show that when they are prescribed antibiotics for sexually transmitted infections (STIs) during ED visits, some 60% fail to fill the prescriptions.¹ The findings are a concern for providers, since adolescents represent nearly half of all diagnosed STIs annually.² In 2017, more than 1.7 million cases of chlamydia were diagnosed, with 45% of cases found among young women ages 15 to 24.³

“We were astonished to find that teenagers’ rates of filling STI prescriptions were so low,” says Monika Goyal, MD, MSCE, assistant chief of the Division of Emergency Medicine and Trauma Services at Children’s National Health System at George Washington University, and the study’s senior author. “Our findings demonstrate the imperative need to identify innovative methods to improve treatment adherence for this high-risk population.”

Goyal and colleagues studied information from two EDs affiliated with Children’s National Medical Center. The study population included teens ages 13-19 who were prescribed antimicrobial treatment from Jan. 1, 2016, to Dec. 31, 2017, after they were diagnosed with pelvic inflammatory disease (PID) or tested positive for chlamydia. Data indicate that of 696 ED visits for diagnosed STIs, 208 teenagers received outpatient prescriptions for antimicrobial treatments, with just 54.1% of those prescriptions filled.¹

Out-of-pocket cost, access to transportation, and confidentiality concerns are just some of the hurdles teenagers may face when it comes to STI treatment, Goyal noted in a press statement.

Confidentiality Concerns Are a Barrier

Recent research published by the CDC indicates that one of every eight sexually experienced teenagers and young adults on their parents’ health insurance plan said they would not seek out sexual or reproductive healthcare advice because their parents might find out.⁴

In the last 30 years, more states have widened minors’ authority to consent to healthcare, including care related to sexual activity, according to information from the Guttmacher Institute. As of June 2019, all 50 states and the District of Columbia permit most minors to consent to STI testing and treatment, with many states including testing and treatment of HIV. Many states permit providers to inform parents that the minor is seeking or receiving STI services when they deem it in the best interests of the patient. (Current updates are available at: https://bit.ly/2K9X2Zw.)

The Society for Adolescent Health and Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists have endorsed that “healthcare providers should be able to deliver confidential health services to consenting adolescents and young adults covered as dependents under a family’s health insurance plan.”⁵ These services include care related to “STIs, contraception, pregnancy, substance use/abuse, and mental health, as well as care for other health issues that an adolescent or young adult considers sensitive.”⁵

Several states have adopted provisions to address confidentiality in the private healthcare billing and insurance claims process. These approaches include identifying situations in which sending an explanation of benefits (EOBs) is not required; sending EOBs for sensitive services to the patient at an address specified by that patient; and specifying that the care to which the minor can consent must be confidential, including in the healthcare billing process.⁵

Protecting confidentiality in healthcare billing and insurance claims is essential in providing healthcare for adolescents and young adults, according to the consensus statements. Healthcare providers must be able to deliver confidential health services to young people covered as dependents under a family’s health insurance plan, the organizations agree.

“Policies and procedures should be established so that EOB notifications do not impede the otherwise confidential provision of healthcare services to adolescents and young adults,” the statement reads.

REFERENCES

1. Lieberman A, Badolato GM, Tran J, et al. Frequency of prescription filling among adolescents prescribed treatment for sexually transmitted infections in the emergency department. JAMA Pediatr 2019; May 28. doi:10.1001/jamapediatrics.2019.1263. [Epub ahead of print.]
2. Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis 2013 Mar;40:187-93.
3. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2017, September 2018. Available at: http://bit.ly/2IK01ph.
4. Leichliter JS, Copen C, Dittus PJ. Confidentiality issues and use of sexually transmitted disease services among sexually experienced persons aged 15-25 years — United States, 2013-2015. MMWR Morb Mortal Wkly Rep 2017;66:237-241.
5. Confidentiality protections for adolescents and young adults in the health care billing and insurance claims process. Pediatrics 2016;137(5).