University Student Health Center Research Articles

Use of Patient-Reported Symptom Data in Clinical Decision Rules for Predicting Influenza in a Telemedicine Setting.

Increased use of telemedicine could potentially streamline influenza diagnosis and reduce transmission. However, telemedicine diagnoses are dependent on accurate symptom reporting by patients. If patients disagree with clinicians on symptoms, previously derived diagnostic rules may be inaccurate. We performed a secondary data analysis of a prospective, nonrandomized cohort study at a university student health center. Patients who reported an upper respiratory complaint were required to report symptoms, and their clinician was required to report the same list of symptoms. We examined the performance of 5 previously developed clinical decision rules (CDRs) for influenza on both symptom reports. These predictions were compared against PCR diagnoses. We analyzed the agreement between symptom reports, and we built new predictive models using both sets of data. CDR performance was always lower for the patient-reported symptom data, compared with clinician-reported symptom data. CDRs often resulted in different predictions for the same individual, driven by disagreement in symptom reporting. We were able to fit new models to the patient-reported data, which performed slightly worse than previously derived CDRs. These models and models built on clinician-reported data both suffered from calibration issues. Patients and clinicians frequently disagree about symptom presence, which leads to reduced accuracy when CDRs built with clinician data are applied to patient-reported symptoms. Predictive models using patient-reported symptom data performed worse than models using clinician-reported data and prior results in the literature. However, the differences are minor, and developing new models with more data may be possible.

Decreasing reproductive and abortion care barriers: findings on the student health center's role from a student survey

BackgroundCollege-aged young adults in the US have low utilization and high need for reproductive healthcare. Multiple barriers to reproductive care exist. University Student Health Centers (SHCs) provide varying degrees of reproductive products and services. Recently, California legislated that public university SHCs add medication abortion to their care.MethodsTo examine existing attitudes and barriers to reproductive healthcare for public university students, we conducted an anonymous online survey at a large, diverse, urban coastal California State University. Students were asked about numerous barriers accessing reproductive services in general and at the SHC, which we categorized into three groups: stigma, access and system. Respondents were also asked about knowledge and preferences for accessing and recommending various services. To understand the extent to which inequities exist, we compared differences across racialized/ethnic identity, gender identity, anticipated degree, and living distance from campus using chi-squared tests.ResultsThe majority of survey (n = 273) respondents experienced stigma and access barriers in general healthcare settings which made obtaining reproductive healthcare for themselves or their partners difficult (stigma barriers 55%; 95% CI 49%–61%; access barriers 68%; 95% CI 62–73%). Notably, students reported statistically significant lower rates of access barriers at the SHC, 50%, than in general reproductive healthcare settings, 68%. There were limited differences by student demographics. Students also reported a high willingness to use or recommend the SHC for pregnancy tests (73%; 95% CI 67–78%), emergency contraception pills (72%; 95% CI 66–78%) and medication abortion (60%; 95% CI 54–66%). Students were less likely to know where to access medication abortion compared to other services, suggesting unmet need.ConclusionsOur study provides evidence that students face barriers accessing reproductive healthcare and that SHCs are a trusted and accessible source of this care. SHCs have a key role in increasing health, academic and gender equity in the post-Roe era. Attention and financial support must be paid to SHCs to ensure success as state legislatures mandate them to expand reproductive and abortion care access.

Providers’ shared decision-making as a predictor of healthcare outcomes for college-aged adults managing upper respiratory tract infections

ObjectivesStrategies that assist patients with upper respiratory tract infections (URTIs) to endorse non-antibiotic treatments are vital to curbing antibiotic resistance. This study examines the potential of shared decision-making (SDM) for improving stewardship-relevant outcomes and investigates patient affect as a mechanism that explains the beneficial impact of perceived SDM. MethodPatients (N = 433) seeking care for URTIs at a university student health center and not prescribed antibiotics completed a pre-visit questionnaire and two surveys one day and 14 days post-visit. The day-one survey assessed perceived SDM, affect, and immediate stewardship-relevant outcomes, and the day-14 survey assessed long-term stewardship-relevant outcomes. ResultsPerceived SDM was negatively associated with negative affect and positively associated with positive affect, favorable perceptions of non-antibiotic treatments and providers, and self-efficacy to manage symptoms and obtain follow-up care. Patient affect and day-one outcomes were mediators between perceived SDM and retrospective self-efficacy two weeks post-visit. ConclusionThe study illustrated the beneficial influence of patient perceived SDM on antibiotic stewardship in both short and long terms and elucidated the mechanisms through which the influence occurs. Practice implicationsSDM can be an effective strategy for primary care providers to improve patients’ outcomes with URTI visits without prescribing unwarranted antibiotics.

1437. Investigation of Increased Latent Tuberculosis Infection Rates During the COVID-19 Pandemic Among International Students at a U.S. University Campus

Abstract Background The COVID-19 pandemic has caused dramatic changes in the epidemiology of many diseases globally due to various changes in exposure to different pathogens, social restrictions, and demographic shifts. A university student health center located in the U.S. Midwest detected an increase in latent tuberculosis infection (LTBI) rate among its incoming international students (INTS) from 5.7% to 8.1% in the fall semesters of 2019 and 2021, respectively. We describe our approach to investigating the increase in LTBI rate at a university campus in a low-endemicity area. Methods Factors that may affect LTBI rates were evaluated. LTBI testing policy and methods were reviewed. Medical and lab staff were interviewed regarding the consistency of specimen collection, transport, and processing. LTBI risks in the general population such as older age, male gender, and country of origin (COO) were also considered. Factors that were expected to be uncommon in the INTS (homelessness, incarceration, and illicit drug abuse) were not evaluated. Results No changes in the INTS screening policy were noted. All incoming INTS were screened for LTBI during initial health screening, regardless of COO. The same manufacturer's QuantiFERON®-TB Plus test was utilized. Compared to previous years, no inconsistencies in the testing logistics were reported. A total of 1,016 INTS were screened in 2019 and 1,179 in 2021. There were no significant differences in average age in years (23.1 vs. 23.3) or male gender (59.6% vs. 56.8%) between 2019 and 2021, respectively. Most INTS came from two countries (A and B). Country A was COO of 21.6% of INTS in 2019, which dropped to 8.4% in 2021. Country B was COO of 44.8% of INTS in 2019, which increased to 57.6% in 2021 (p< 0.001; Figure 1). Although LTBI rates within each country (A and B) remained similar before and during the COVID-19 pandemic (Figure 2), country B had consistently higher rates than country A (p< 0.001), which contributed to the overall increased rate of LTBI in 2021. Figure 1.Numbers and percentages of international students from countries A and B.Figure 2.LTBI positivity rates for countries A and B before and during COVID-19 pandemic. Conclusion Evaluating changes in COO of INTS is essential in investigating trends in LTBI rates at otherwise low-endemicity universities. In our investigation, demographic changes in university admissions over two years relative to COVID-19 pandemic restrictions contributed to an increase in the overall LTBI rate. Disclosures Moises A. Huaman, MD, MSc, Gilead: Grant/Research Support|Insmed: Grant/Research Support.

Implementation of a pharmacist-led hormonal contraceptive prescribing service in a campus community pharmacy in Indiana, United States

Objective(s)College-age people have the highest numbers of unintended pregnancies and pharmacies within college campuses are in a unique position to meet student needs. Our objective was to implement a pharmacist contraceptive prescribing service in a campus pharmacy and examine the service utilization. Study designThe Purdue University Pharmacy (Indiana, United States) implemented a pharmacist hormonal contraception prescribing service via a collaborative drug therapy management agreement with the campus student health center. The collaborative drug therapy management agreement enables pharmacists to independently prescribe pills, patches, rings, injections, and emergency contraception to students meeting eligibility criteria. After completing a patient health screening and blood pressure check, the pharmacist discusses the eligible method(s) and prescribes up to a 12-month supply. A referral to another provider for long-acting reversible contraception or further evaluation may also be provided. We collected basic information about each encounter (e.g., age, blood pressure, method of contraception prescribed, and time). ResultsDuring the 2020–2021 academic year, 125 prescribing consultations took place with an average appointment length of 20 minutes (range, 12–65 minutes). The median patient age was 21 years (range, 18–30 years). Eligible patients (n = 123, 98%) received a prescription and 119 (95%) prescriptions were written: combined oral pill (n = 91, 77%), injection (n = 12, 10%), patch (n = 6, 5%), vaginal ring (n = 5, 4%), and progestin only pill (n = 5, 4%). Conclusion(s)The pharmacist contraception prescribing service developed by the Purdue University Pharmacy and Student Health Center is a unique approach to meeting the needs of students. Few external resources are required for implementation, and most patients were medically eligible to receive hormonal contraception. ImplicationsCollaboration between on-campus student health centers and pharmacies can be explored as 1 approach to increase access to hormonal contraception for students.

Contraception information on the websites of student health centers in the United States

ObjectiveAs University Student Health Centers are considered reputable sources of information by many young adults, we evaluate the presence of contraceptive information on their websites. Study DesignWe used a software tool (Quantitative Measures of Online Health Information), designed for public health research to examine online information access on four broad categories of contraception and reproductive health (LARC/injectables, Contraception, Condom, Pap test) on student health center websites from all (591) public four-year universities across the United States between July to September 2020. Using a logistic regression model, we documented factors that are associated with information disparities. ResultsOur sample consisted of 545 public universities after excluding those for which information was unavailable. In 357 (66%) of the universities in our sample, we found evidence of some information related to contraception. A one percentage point increase in the student population that are Pell grant recipients, an indicator of the proportion of low-income students enrolled, is associated with a 3% to 6% (0.01<p<0.05) decrease in the odds of the presence of contraception information. A one percentage point increase in the student population that is female is associated with a 3% to 6% (0.01<p<0.1) increase in the odds of the presence of contraception information. Universities that offer medical degrees have an 82% (p<0.1) higher odds of providing information for LARC/injectables on their websites. Universities that have an institutional size of more than 10,000 students are almost four times (p<0.01) as likely to have contraception information on their websites relative to those with a smaller institutional size. ConclusionsInformation on contraception on University student health center websites is associated with on a host of factors related to student demographics, institutional characteristics, and university location. ImplicationsExamining student health center websites for contraception information can reveal important systemic gaps, especially at universities that serve nontraditional or vulnerable groups. An ongoing review is necessary to ensure equal access for all college students.

Use of a Smartphone Medication Reminder Application to Support Emerging Adult Adherence to Non-Antibiotic Treatment for Viral Upper Respiratory Tract Infection.

Objective:This research study is a test of the efficacy of a smartphone-installed medication reminder application to support provider-recommended treatment plans for young adult patients who were seen for upper respiratory tract infections (URTIs) and were not prescribed an antibiotic.Methods:Two hundred seventy-five patients seen at a university student health center for URTI symptoms were randomly assigned to the medication reminder app intervention or a control group and then surveyed both 1 and 14 days after their medical visits with questions about the treatment plan, their satisfaction with medical care, and the electronic support tools.Results:Compared to the control condition, patients using the reminder app reported more adherence to provider-recommended treatment plans. Patients with lower social support availability benefited more from being provided with these tools.Conclusion:These findings suggest that medication reminder apps have utility for increasing patient adherence to non-antibiotic URTI treatment plans, particularly among patients who lack high-quality informational and tangible social support.Innovation:This study demonstrates innovation in use of the medication reminder app to promote antibiotic stewardship with young adult patients in primary care.

Impact of perceived contraceptive policy changes on long acting reversible contraception dispensing trends

Objective We observed the long-term trend of Long Acting Reversible Contraception (LARC) usage before and after the 2016 presidential election. Methods We observed the rate of LARC dispensed at a university student health centre in the 18 months preceding and 27 months following the 2016 U.S. presidential election which posed threat to contraception access. We applied a segmented regression model using two linear regression line segments to evaluate whether there is a time point where the trend of LARC dispensing changed. We fit the regression models with a breakpoint at month 0 (election month) and 3 months with a Locally Estimated Scatterplot Smoothing (LOESS) estimate with parameters obtained by estimating simple linear regression models separately below and above the breakpoint ‘0’. Results There were a total of 2067 LARC methods dispensed from May 2015 to February 2019. The average number of LARC methods dispensed before November 2016 was 38/month and increased to 51/month post-presidential election. The LARC dispense rate significantly increased each month (0.38, 1.74; 95% confidence level, p < 0.05) until a breakpoint at 6 months (standard error 4.11) post-election followed by slower decrease (–0.59/month, 95% confidence level: −1.37, 0.20; p=not significant). Conclusion Our study is the first to report long-term trends (27 months post-election) in LARC uptake amidst the public discourse that suggested the end of a policy that provided LARC insurance coverage. Although this observational study cannot suggest causality, the findings could reflect actions taken to prevent unintended pregnancy in response to the event of uncertain national policy.

O5 Evaluation of a Food Insecurity Screen and Intervene Program in University Student Health Centers

Objective To evaluate the feasibility and efficacy of a food insecurity screen and intervene program in a university student health setting. Use of Theory or Research While food insecurity is a significant problem for many college students, connecting students to available on-campus resources has proved challenging. Target Audience Food insecure college students who use university health care services. Program Description Students visiting university health centers were screened for food insecurity (FI) using a 2-item screener embedded in a larger questionnaire administered online prior to students’ first appointment of the academic year. FI students were referred to on-campus food resources; specifically, they were given a “prescription” postcard with information about the student food pantry and Dean of Students office. Evaluation Methods We used a mixed-method evaluation, including semi-structured qualitative interviews with health services staff and clinicians (n = 18), and with FI students who were identified through the screener process (n = 8). In addition, we matched data from students who completed the FI screener (n = 5804) with on-campus food support usage. Results Out of over 11,000 students who had an appointment with student health services, approximately 50% completed the FI screener. Among those who screened, 563 (9.7%) were FI. Among the FI students, 55 (9.7%) used the food pantry and 124 (22%) used the Dean of Students office during the study period. Health care practitioners reported largely positive impressions of the program, including ease of use and perceived value, while also raising issues of language barriers and potential bias in the screener interpretation process. Student interviews identified ways in which practitioner and student perceptions of the program both overlapped and diverged. Conclusion This program was well-received by university health care practitioners and students, and, while many of the referred FI students used the on-campus supports, there is room for improvement in encouraging FI students to use available resources. Funding None.

Knowledge, attitudes, and practices related to human papillomavirus vaccination among college students in a state university: Implications for nurse practitioners.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and disproportionately affects adolescents and young adults. Although a safe and efficacious vaccine is available, many college students are unimmunized against HPV. Most students presenting to college health centers are within the age range for catch-up immunization, giving nurse practitioners (NPs) in this setting an opportunity to increase vaccination rates. More information is needed about college students' HPV knowledge, attitudes, and vaccination uptake so that NPs can make effective vaccine recommendations to this population. To examine (a) Knowledge and attitudes about HPV and its vaccine; (b) HPV immunization practices; and (c) factors associated with HPV knowledge, attitudes, and vaccination among college students in a US university. This cross-sectional quantitative study collected data from participants in a state university student health center. Data collected included knowledge, attitudes, and practices about HPV and its vaccine from 627 students. Participants had a moderately low HPV knowledge but positive attitudes toward HPV and its vaccine. Participants with a higher level of HPV knowledge were US born, health-related majors, married or divorced, and had positive attitudes. Higher HPV knowledge, vaccine uptake, and a family history of cervical cancer were associated with positive attitudes. Predictors for vaccine uptake include being a health-related major and positive vaccine attitudes. The results of this study help NPs, registered nurses, and other health care providers make effective HPV vaccine recommendations to college students. Students with positive HPV attitudes can serve as peer educators to increase HPV vaccination awareness in this population.

Factors associated with repeat rectal Neisseria gonorrhoeae and Chlamydia trachomatis screening following inconclusive nucleic acid amplification testing: A potential missed opportunity for screening.

ObjectiveGiven rising incidence of Neisseria gonorrhoeae and Chlamydia trachomatis (GC/CT), development of efficacious screening strategies is critical to interruption of the infection cycle. However, a small proportion of nucleic acid amplification testing (NAAT) results are inconclusive—resulting in delays in diagnosis and treatment. As such, this study seeks to evaluate factors associated with inconclusive rectal GC/CT NAAT.MethodsThis is a retrospective chart review of individuals who received an inconclusive rectal GC/CT NAAT result at a single institution from 3/2016-6/2018. Inconclusive GC/CT NAAT was defined as presence of PCR amplification inhibitors using Roche Cobas v2.0 CT/NG assay. Clinical charts were abstracted for age, gender, HIV status, GC/CT (urogenital, rectal, pharyngeal) and syphilis screening results during the study period, clinic type (HIV clinic, university student health center, other), and whether repeat testing occurred within 6 months following an inconclusive result. Logistic regression analysis was used to calculate adjusted and unadjusted odds ratios of factors associated with receipt of repeat testing following an inconclusive rectal GC/CT NAAT result.ResultsDuring the study period, 6.1% (852/14,015) of rectal GC/CT NAAT were inconclusive for one or both of GC and CT. Among the 413 patients whose inconclusive rectal GC/CT NAAT results that were included in our analysis, 66.6% (275/413) received repeat testing within 6 months, of which 8.7% (24/275) were positive (compared to 5.4% positivity rate of all rectal samples). In multivariable analysis, individuals living with HIV had lower odds of receiving repeat testing following inconclusive rectal GC/CT NAAT compared to HIV uninfected individuals (adj OR 0.25; p = 0.001).ConclusionsDespite being disproportionately affected by the STI epidemic, individuals living with HIV had 75% lower odds of receiving repeat testing following inconclusive rectal GC/CT NAAT compared to HIV-uninfected individuals, representing potentially missed opportunities for treatment and prevention of ongoing STI transmission.

PRACTITIONER APPLICATION: First Case On-Time Starts Measured With Incision On-Time and No Grace Period: A Case Study of Operating Room Management.

medical director, New York University Student Health Center, New York City, New York The author declares no conflicts of interest.

Associations between antibiotic prescriptions and recurrent urinary tract infections in female college students.

Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes - where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal coinfection and birth control consultation. There were 1051 instances of infection recurrence among the 6620 patients, indicating a prevalence of 16%. In the analysis of patient characteristics, Asian women were statistically more likely to experience infection recurrence whereas African American were less likely. No significant associations were identified between the antibiotic administered at the initial infection and the risk of infection recurrence after multivariable adjustment. Treatment with trimethoprim-sulphamethoxazole and being born outside of the USA were significantly associated with increased odds of infection relapse in the multivariate analysis. The results of the analyses suggest that treatment with trimethoprim-sulphamethoxazole may lead to an increased risk of UTI relapse, warranting further study.

Prevalence of female sexual dysfunction among women attending college presenting for gynecological care at a university student health center

Objective: To estimate the prevalence of female sexual dysfunction (FSD) among women attending college (18–29 years of age) presenting for routine gynecological care at a university-based student health center. Participants: Location: University affiliated women’s health care clinic. Methods: Study design: Descriptive, cross sectional study. Primary endpoint: Estimated prevalence of FSD in the 18–29-year- old population. A subanalysis between those with and without recent sexual activity was performed. Logistic Regression was performed to identify potential predictors of FSD among those affected. Results: Of 310 women, FSFI was estimated as ranging from 35.5% (not sexually active) to 42.3% (sexually active). Those of younger age (18–21), with prior mental health diagnosis, and self-reported problems with arousal were at increased risk for FSD. Conclusion: Screening for FSD in the 18–29-year-old population is justified and recommended.

Computer self-administered screening for substance use in university student health centers

Objective: To characterize the prevalence of tobacco, alcohol, and drug use and the acceptability of screening in university health centers. Participants: Five hundred and two consecutively recruited students presenting for primary care visits in February and August, 2015, in two health centers. Methods: Participants completed anonymous substance use questionnaires in the waiting area, and had the option of sharing results with their medical provider. We examined screening rates, prevalence, and predictors of sharing results. Results: Past-year use was 31.5% for tobacco, 67.1% for alcohol (>4 drinks/day), 38.6% for illicit drugs, and 9.2% for prescription drugs (nonmedical use). A minority (43.8%) shared screening results. Sharing was lowest among those with moderate-high risk use of tobacco (OR =0.37, 95% CI 0.20–0.69), alcohol (OR =0.48, 95% CI 0.25–0.90), or illicit drugs (OR =0.38, 95% CI 0.20–0.73). Conclusions: Screening can be integrated into university health services, but students with active substance use may be uncomfortable discussing it with medical providers.

Evaluating the capacity of California's publicly funded universities to provide medication abortion

ObjectiveTo explore capacity of University of California (UC) and California State University (CSU) student health centers (SHCs) to provide medication abortion (MA) and SHC staff perspectives on providing MA. Study designSHC staff completed an online survey; we conducted site visits and conference calls with a subset of SHCs. The survey focused on barriers to abortion, resources needed for MA, and potential benefits and challenges. Results11 UCs (100%) and 20 CSUs (87%) completed surveys. All facilities provided basic primary care, including sexual and reproductive health services and some contraceptive services, but not abortion. All sites had adequate staffing and physical plant, but most would require training, access to ultrasound when needed, 24-hour hotlines (CSUs), and back-up care to provide MA. ConclusionIt would be feasible to provide MA at SHCs, but investment is needed to support staff training, equipment, 24-hour hotlines, back-up care, and minimal security upgrades, in order to implement MA services. ImplicationsIf SB320 is passed, provision of MA services at student health centers could improve access to early abortion for students in California. This model may be scaled up at other universities around the country.

An Electronic Medical Record Alert Intervention to Improve HPV Vaccination Among Eligible Male College Students at a University Student Health Center.

This pilot study aims to improve HPV vaccination for college aged males at a student health center. The first part of the study consisted of a focus group that assessed the barriers and facilitators of HPV vaccination among healthcare providers and clinic staff (N = 16). Providers reported missed opportunities for HPV vaccination. For the second part of the study, providers and staff reviewed medical records of patients ages 18-26 with student health insurance and with < 3 doses of the HPV vaccine at baseline (12/1/2014 to 7/31/2015) and follow-up (12/1/2015 to 7/31/2016). A computer-automated EMR alert was generated in the medical record of eligible male patients (N = 386). Z-scores were estimated for two-sample proportions to measure change in HPV vaccine rates at baseline and follow-up for males and females. HPV vaccine initiation rates increased among males (baseline: 5.2% follow-up: 25.1%, p < 0.001). This study shows that EMR alerts improved HPV vaccine initiation rates among insured college-aged males.

I am a United Academic Worker.

Nine days before my scheduled dissertation defense, my then-spouse and I split up. I was able to navigate this enormous life event and get through my defense with the support of a counselor, provided by my university's student health center. When my father received a chilling medical diagnosis, this resource again helped me cope. But shortly afterward, I was suddenly turned away from the counseling I had relied on. My adviser and I had decided that I would stay on for about a year as a postdoctoral researcher, which rendered me ineligible for these services. My experience is just one example of the poor working conditions awaiting postdocs—and why I've become involved in efforts to form a postdoc union at my university.

Screening and management of overweight and obesity at a university student health center.

This article discusses a quality improvement project focused on developing, implementing, and evaluating an evidence-based best practice protocol for screening and management of overweight and obesity in college students in a university-based student health center.

Use and interest in complementary and alternative medicine among college students seeking healthcare at a university campus student health center

BackgroundThere is growing data on complementary and alternative medicine (CAM) preferences among college students. While several studies have focused on undergraduate students, there is limited data on graduate students. Materials and methodsCross sectional analysis of undergraduate and graduate students seeking medical care at the University of California Irvine's Student Health Center (SHC). The survey assessed previous CAM use and preferences for future CAM use and education. ResultsThe majority (67.0%) had used CAM within the last year, 27.0% would use CAM for their current health condition, and 51.9% would consider CAM for their current health condition if they were more knowledgeable. Most respondents desired more CAM education and indicated that they would try CAM modalities if covered under insurance. ConclusionMost college students requested more knowledge to assist in their decisions to use CAM. These findings provide insight for health centers on the preferences of college student patients.