247 - A Digital Referral Tool to Link Adolescents to Sexual Healthcare from the Emergency Department: A Cohort Study

Publication Number: 3239.247

Lisa-Pierre Tchoungui, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Talia G. Adler, Columbia University Vagelos College of Physicians and Surgeons, Hamden, CT, United States; Janet Garth, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Ana G. Cepin, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Lauren Chernick, Columbia University Vagelos College of Physicians and Surgeons, Harrison, NY, United States

Background: Emergency departments (EDs) often miss opportunities to address adolescents' sexual and reproductive health (SRH) needs due to time and resource constraints. To bridge this gap, we developed Dr. Erica (Emergency Room Intervention to improve Adolescent Care), a digital sexual health text-based intervention after ED visits. In a prior trial, although initiation rates did not improve, it increased readiness for contraception, suggesting that integrating person-centered SRH counseling and linking to preventive sexual healthcare could enhance impact.

Objective: This study aimed to develop and pilot test the Dr. Erica Digital Referral Tool (Dr.E-DRT), a patient-facing tool designed to educate adolescent females and facilitate linkage to person-centered sexual healthcare after ED discharge.

Design/Methods: We conducted a prospective cohort study from July 2023 to February 2024 in an urban pediatric ED. Biologically female, English-speaking adolescents aged 14-19 years were screened for eligibility. The tool was developed through a user-centered design process incorporating adolescent input and expert review to ensure engaging, person-centered content. Enrolled participants completed a baseline survey, interacted with the Dr.E-DRT and were offered the option to schedule a follow-up appointment for SRH care. Two-month follow-up was completed via survey and electronic medical record (EMR) review. Outcomes included feasibility, acceptability, and potential efficacy to increase outpatient follow-up.

Results: The Dr. E-THT (Figure 1) was refined iteratively using the feedback from key stakeholders and patient interviews. As seen in Figure 2, we screened 223 adolescents to find 31 who met eligibility criteria; 25 were enrolled (Figure 2). All participants (Table 1) completed the tool, and 16 participants (64%) scheduled a follow-up visit at our local family planning practice. The acceptability of Dr. E-DRT was high across multiple dimensions, with mean Likert scores ranging from 4.2 to 4.4 out of 5 for satisfaction, appeal, and likelihood of recommending the tool. At 2-month follow-up, survey completion was 40% (10/25). Only three participants attended the follow-up visit.

Conclusion(s): Dr.E-DRT was feasible to implement and acceptable to adolescents in the ED. While appointment scheduling was high, visit completion remained low, highlighting the need for additional strategies to support linkage to SRH care after an ED visit.

Figure 1. Screenshot of Dr.E-THT
This is a screenshot of the first page of the Dr.E-THT

Table 1. Demographics of enrolled population


Figure 2. CONSORT diagram