Sexual health is an essential part of every individual’s overall health and well-being, and primary health care professionals should ask about a patient’s sexual history as part of their comprehensive health history during primary care visits. But in busy healthcare practices, it is not uncommon for providers to skip the sexual history unless a patient shows signs or symptoms of sexually transmitted diseases (STDs). Providers may also avoid taking sexual histories because they do not feel comfortable asking sensitive and potentially embarrassing questions, or they do not feel prepared to ask those questions in a culturally competent manner when their patients are lesbian, gay, bisexual or transgender (LGBT). Fortunately, a new resource is available to help them do so.
To support health centers as they work to better integrate sexual health into patient-centered care, the Fenway Institute’s National LGBT Health Education Center collaborated with the National Association of Community Health Centers (NACHC) to create Taking Routine Histories of Sexual Health: A System-Wide Approach for Health Centers (Toolkit). Both the Center and NACHC are National Cooperative Agreement partners of the Health Resources and Services Administration’s (HRSA) Bureau of Primary Health Care (BPHC).
The toolkit provides resources for establishing the routine collection of sexual health histories during primary care visits, including:
- Tips for putting the patient at ease;
- Recommended screening questions and subsequent risk assessments;
- An algorithm (flow chart), with suggested “next steps” for each patient response;
- Tips for how providers and other members of the clinical care team can be sensitive to and inclusive of special populations, including patients who are transgender and men who have sex with men; and
- Tools such as suggested staff roles and responsibilities, sample wording for intake forms, diagnosis codes related to sexual history and screening, and examples of how to incorporate risk assessment forms into electronic medical records.
- The toolkit emphasizes the importance of integrating sexual health into overall patient health care and patient engagement, stressing that sexual history information should be taken from all patients, regardless of gender, race, ethnicity, socioeconomic status, sexual orientation, and gender identity.
Ultimately, health center attention to patient sexual health reflects a commitment to improved community health and patient-centered care. In a health center that provides patient-centered care, the care team is prepared to:
- Engage each patient in a discussion of his or her sexual health,
- Collect data and information that guides clinical care decisions and goals of the care team and the patient regarding sexually transmitted infections (STIs) and sexual behaviors; and
- Coordinate the sexual health preventive and treatment service needs of the patient.
Routinely assessing and documenting every patient’s sexual history is important because sexual health is at the very core of every individual’s health and wellness. Studies show that patients want to talk to their healthcare providers about sexual concerns, but providers often don’t bring the topic up. By knowing how to take a sexual history, providers and other members of the clinical team are better able to educate and counsel patients about HIV, STDs, and viral hepatitis, and connect their patients to appropriate treatment and care. Without taking a sexual history, some diseases—including HIV—may remain undiagnosed and untreated for long periods of time until they lead to more serious illness. This leaves the patients without the essential knowledge they need to take steps to protect their own health and to prevent transmitting the disease to others.
“Health centers provide preventive and primary care services to more than 21 million patients every year, reaching economically distressed and vulnerable populations who are most at risk for many health concerns, including HIV, STDs, and viral hepatitis,” said Dr. Seiji Hayashi, BPHC’s Chief Medical Officer. “Helping providers ask questions so that they can better understand the full picture of their patients’ health is part of BPHC’s ongoing commitment to ensuring that health centers provide the highest quality care in a culturally-competent manner to improve health and prevent disease.”
The toolkit is available online for download and includes a PowerPoint presentation that can be used in staff training. While it is specifically designed for use by health centers, it is adaptable for use by other health care organizations. If you work with a health center or other provider of clinical care, consider sharing this resource with them.In addition to the toolkit, NACHC developed a webpage dedicated to Sexual Health that features, the toolkit, associated resources and a companion video series entitled, “HIV and Related Issues: Engaging Patients and Communities.” NACHC’s Sexual Health portfolio is part of a larger strategy to engage health centers in communicable disease prevention, care, and treatment. Focus groups with health center consumer board members and interviews with primary care associations and public health departments guided NACHC’s work in this area. This series of 4 short videos highlights health centers as an integral part of our nation’s response to the critical issues of HIV, hepatitis C, and sexual health. Addressing these issues, often through active partnerships, is essential in a true Patient Centered Medical Home and in fully engaging our patients, families, and communities.