Objective:

To analyze documentation of pediatric neurologists’ counseling regarding sexual and reproductive healthcare (SRH) for adolescent women with epilepsy (WWE)

Background:

The American Academy of Neurology (AAN) recommends annual SRH counseling for WWE beginning at menarche. Pediatric neurologists self-report discussing SRH concerns infrequently with adolescent WWE. Documentation of such counseling has not been defined.

Design/Methods:

We retrospectively studied outpatient pediatric neurology notes (n=3663) for WWE age 13-21 using natural language processing to investigate documentation of SRH counseling. Notes were segmented into 388,019 sentences and evaluated for references to SRH counseling regarding: menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in Watchful and utilized spaCy machine learning to identify additional counseling instances. We repeated this process iteratively until no new relevant sentences were identified. Two external reviewers assessed for validity (n=400 sentences, Cohen’s kappa for all categories >0.88); we then removed sentences reviewers disagreed on (n=13) and calculated kappa values between the model and reviewers (>0.98). We evaluated aggregated labeled texts for each patient per calendar year (n=2277 patient-years) with descriptive statistics and logistic regression (adjusting for race, age, and teratogen use).

Results:

Nearly half of patient-years had no mention of SRH counseling (49.1%). Among 971 WWE, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of teratogens (OR=1.26, p=0.020; OR=1.27, p=0.028). Documentation regarding contraception, folic acid, and sexual activity was associated with older patients (OR=1.28, p=0.000; OR=1.26, p=0.000; OR=1.26, p=0.004). Documentation of sexual activity was decreased among patients identifying as White (OR=0.40, p=0.012).

Conclusions:

Pediatric neurologists counsel WWE on SRH less frequently than recommended by the AAN based on chart documentation.