Medical follow-up at the Sexual Assault Centre in Oslo

Discussion

Among patients who accepted medical follow-up at the Sexual Assault Centre in Oslo, almost half attended one or more planned appointments. Most non-attendance related to the first medical follow-up. Of those who initially missed their appointment and were subsequently contacted, three out of five eventually attended. Many reported that appointments with the police, lawyers or other services led to them forgetting about their appointment or limited their capacity to attend. Sleep problems and avoidance behaviour are common post-traumatic reactions (6) and can make it difficult to remember and keep appointments.

Seeing the same healthcare personnel in the follow-up as in the acute phase may reduce non-attendance (7). The Sexual Assault Centre therefore tries to ensure patients meet the same staff during follow-up. The fact that only half of patients saw the same doctor at each follow-up, and just 13.5 % saw the same nurse, confirms the need for solutions that facilitate continuity of care.

We hypothesised that patients who received post-exposure prophylaxis (PEP) for HIV would be more likely to attend follow-up due to concerns about infection and the need for follow-up tests. It was therefore somewhat surprising that approximately three-quarters of patients attended follow-up, regardless of whether they received PEP. One possible explanation is the generally high overall attendance rate, which can make it difficult to identify differences between subgroups.

Thirty to forty per cent of patients who have experienced sexual assault currently have or have had problems with mental health or substance use (8). In our study, 13.1 % were referred to mental health services. We only recorded new referrals, and did not track whether patients were put in contact with an existing provider or independently sought low-threshold services. Consequently, the proportion of patients receiving mental health follow-up is likely higher than our figures suggest.

Only 2.4 % of the women were referred to a gynaecologist for issues arising after the assault. These referrals were not necessarily due to physical injuries, as such injuries are often not observed during examination at a sexual assault centre.

We considered it useful for the patient's GP to be informed of the assault, due in part to the risk of long-term health consequences and the potential reactivation of post-traumatic reactions during life events such as pregnancy and childbirth. Discharge summaries are provided solely with the patient's consent and are not sent as a matter of routine. Many of our patients, due to age or life circumstances, do not have an established relationship with a GP. Others did not want their GP to be informed about the assault. Discharge summaries were therefore sent to the GP for only 40.2 % of patients. A small proportion explicitly declined, but in the majority of cases, there was no record of whether a decision regarding this had been made. The Sexual Assault Centre has therefore added this as a separate item in the template for medical follow-up.

Overall, three out of four patients attended one or more medical follow-up appointments, as reported in a study from the same centre covering the period 2017–2019 (9). The organisation of sexual assault services and access to follow-up vary considerably across Norway. To ensure an equitable healthcare provision, national clinical guidelines need to be devised for the medical follow-up of individuals who have experienced sexual assault.