Cleveland Clinic Akron General, Akron, OH
Improving Primary Care Follow-Up After Sexual Assault

Background: More than 320,000 US adults are sexually assaulted yearly. Sexual assault nurse examiners provide trauma care and perform forensic medical examinations and evidence collection. Medical follow-up after sexual assault plays a significant role in the physical, mental, and emotional healing process. Essential care provided at a primary care follow-up after the initial forensic medical examination includes injury and medication follow-up, sexually transmitted infections testing, and referrals for counseling and/or advocacy. Historically, the reported follow-up rates after a medical forensic examination for sexual assault are low (31%-35%). Patients who suffer sexual assault often experience a disparity in follow-up healthcare and treatment of related and subsequent medical and psychiatric conditions.

Methods: The study period was May 1, 2016 through October 31, 2016. Coordination of follow-up care was offered to all patients ≥18 years who underwent a forensic medical examination and evidence collection kit for sexual assault. A sexual assault nurse examiner or social worker scheduled follow-up appointments for patients who agreed. Patients with appointments were mailed letters verifying dates, times, and physician locations. Letters including patient information, suggested follow-up testing, and patient needs were mailed to the physicians. Appointment compliance was verified via patient self-report and chart review.

Results: Sixty patients were included in the study. Of them, 38 (63%) were covered by Medicaid and 16 (27%) were uninsured. Of the 60 patients in the study, 34 (57%) agreed to schedule follow-up appointments. Twenty of those 34 patients (59%) saw their physician for follow-up. Of the 26 patients (43%) for whom appointments were not scheduled, 24 (92%) declined follow-up calls and an appointment, and 2 (8%) were homeless without the ability to receive calls or to get to an appointment. The follow-up for patients who agreed to be contacted and to schedule appointments was higher than historic reports (59% vs 31%-35%), but the follow-up rate for the entire study population remained consistent with previously published data at 30%. Communication and transportation were identified as barriers to follow-up.

Conclusion: Patients who agreed to follow up and scheduled their own appointments had the highest follow-up rates. Further study needs to identify why patients refuse follow-up appointments or calls, but these data will be difficult to obtain because of the nature of the study population presenting after an acute sexual assault. Resources to assist patients with communication and transportation needs may improve follow-up.