Concentration: Women's Reproductive Health

Project Mentor: Donna M. Lafontaine, MD, Lori Boardman

Graduation Year: MD 2011

Concentration Title:
Sexual Assault and Evaluation of Quality of Care: STI, HIV and Pregnancy Prevention

Concentration Description:
The focus of my scholarly concentration over the last three years has been the medical care, specifically examining the prophylactic medical services, provided to victims of sexual assault. As such my project involved two parts. The first was the creation of a Sexual Assault Resource Handbook. The second part was a retrospective cross-sectional study with the objective to determine the percentage of sexually assaulted female patients offered prophylaxis for sexually transmitted infections, HIV infection and pregnancy and to identify factors associated with the provision of prophylaxis. The Sexual Assault Resource Handbook was created by myself and Dr. Donna Lafontaine with the intent that is would be used by the Women and Infants’ Hospital emergency room staff when treating victims of sexual assault. There are a number of specific medical, legal and psychosocial issues related to the care of a patient who has been sexually assault, all of which are addressed in this handbook. The handbook covers information for nurses and physicians on: the initial intake and triage of these patients, Rhode Island state laws, mandatory reporting laws, how to complete a forensic exam and sexual assault evidence collection kit, testifying in court, legal procedures necessary if the patient plans to press charges, STI treatment and prophylaxis, HIV prophylaxis, emergency contraception, follow up care, patient mental health care, and crisis intervention. This book is meant to be a comprehensive guide and resource to all staff members and is currently available in the Women and Infants emergency department being used by the staff. As mentioned above, the second portion of my scholarly concentration project was a cross-sectional study of 210 women presenting at Women and Infants’ Hospital for evaluation following sexual assault between April 1, 2006 and April 20, 2008. large, urban women’s hospital. Data extracted from patient medical records included demographic characteristics and selected quality of care measures, including prophylaxis for STIs and HIV infection, as well as pregnancy prevention. The results of this study demonstrated that the patient population was young, racial and ethnically diverse, and less likely to be privately insured. Additionally we found that the need for emergency contraception was assessed and offered to patients in 99% of the population at risk for pregnancy. HIV prophylaxis was less frequently offered and factors associated with decreased likelihood of HIV prophylaxis provision included insurance status, as women with government assistance or no insurance were offered prophylaxis less often than those who were privately insured. Lastly we found that women over age 50 less often were provided with prophylaxis for Chlamydia, Gonorrhea and Syphillis as compared to women under age 50. The conclusion of this study was that the majority of patients were offered appropriate prophylactic care, although age related differences emerged with regards to provision. After its completion, this study was accepted as a poster presentation at the ACOG annual meeting in May 2009 held in Chicago. A paper has been written and is currently being edited with the plan to submit for journal publication.