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Mehus CJ, Gewirtz O'Brien JR, Gower AL, Klein JD, Santelli JS, Sieving RE, McRee AL. Opportunities to Improve Adolescent Sexual and Reproductive Health Services in Primary Care Clinics. Clin Pediatr (Phila) 2022:99228221142691. [PMID: 36475405 DOI: 10.1177/00099228221142691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Primary care providers are well positioned to address the sexual and reproductive health (SRH) needs of adolescents; however, gaps often exist in the delivery of quality SRH services in primary care. Our objective was to identify specific opportunities to improve the delivery of adolescent SRH services in primary care. We conducted in-depth interviews with 25 primary care providers from various disciplines across rural and urban areas of Minnesota and conducted thematic analysis of transcribed data. Participants identified salient opportunities in three areas: (1) training and resources for providers (e.g., related to minor consent laws or addressing sensitive subjects), (2) practices and procedures (e.g., time-alone procedures and policies for confidential screening and sharing test results), and (3) education for adolescents (e.g., knowing their rights and accessing confidential SRH services). Study findings provide actionable opportunities to improve delivery of adolescent SRH services in primary care.
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Affiliation(s)
- Christopher J Mehus
- Department of Family Social Science and Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN, USA
| | | | - Amy L Gower
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois Chicago, Chicago, IL, USA
| | - John S Santelli
- Department of Population & Family Health and Pediatrics, Columbia University, New York, NY, USA
| | - Renee E Sieving
- Department of Pediatrics, School of Nursing, University of Minnesota, Minneapolis, MN, USA
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Sieving RE, Mehus C, Gewirtz O’Brien JR, Steiner RJ, Wang S, Catallozzi M, Gorzkowski J, Grilo SA, Kaseeska K, McRee AL, Santelli J, Klein JD. Correlates of Sexual and Reproductive Health Discussions During Preventive Visits: Findings From a National Sample of U.S. Adolescents. J Adolesc Health 2022; 70:421-428. [PMID: 34838444 PMCID: PMC9066357 DOI: 10.1016/j.jadohealth.2021.10.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/03/2021] [Accepted: 10/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE This study examines characteristics of healthcare delivery, providers, and adolescents associated with provider-adolescent discussions about sexual and reproductive health (SRH) during preventive visits. METHODS Data were from a 2019 national internet survey of U.S. adolescents ages 11-17 years and their parents. Adolescents who had a preventive visit in the past 2 years (n = 853) were asked whether their provider discussed each of eight SRH topics at that visit: puberty, safe dating, gender identity, sexual orientation, whether or not to have sex, sexually transmitted infections including human immunodeficiency virus, birth control methods, and where to get SRH services. Eight multivariable logistic regression models were examined (one for each SRH topic as the outcome), with each model including modifiable healthcare delivery and provider characteristics, adolescent beliefs, behaviors, and demographic characteristics as potential correlates. RESULTS Provider-adolescent discussions about SRH topics at the last preventive visit were positively associated with face-to-face screening about sexual activity for all eight topics (range of adjusted odds ratios [AORs] = 3.40-9.61), having time alone with the adolescent during that visit (seven topics; AORs = 1.87-3.87), and ever having communicated about confidentiality with adolescents (two topics; AORs = 1.88-2.19) and with parents (one topic; AOR = 2.73). Adolescents' perception that a topic was important to discuss with their provider was associated with provider-adolescent discussions about seven topics (AORs = 2.34-5.46). CONCLUSIONS Findings that provider-adolescent discussions about SRH during preventive visits were associated with modifiable practices including time alone between providers and adolescents and screening about sexual activity can inform efforts to improve the delivery of adolescent SRH services within primary care.
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Affiliation(s)
- Renee E. Sieving
- School of Nursing, University of Minnesota, Minneapolis, Minnesota,Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota,Address correspondence to: Renee E. Sieving, Ph.D., R.N., University of Minnesota School of Nursing, 5-140 Weaver Densford Hall, 308 Harvard Street S.E, Minneapolis, MN 55455. (R.E. Sieving)
| | - Christopher Mehus
- Center for Applied Research and Educational Improvement, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota
| | | | - Riley J. Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shuo Wang
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Marina Catallozzi
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University Medical Center, New York, New York,Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Julie Gorzkowski
- Department of Healthy Resilient Children, Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Stephanie A. Grilo
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Kristen Kaseeska
- Department of Healthy Resilient Children, Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Jonathan D. Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago Illinois
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Pampati S, Liddon N, Dittus PJ, Adkins SH, Steiner RJ. Confidentiality Matters but How Do We Improve Implementation in Adolescent Sexual and Reproductive Health Care? J Adolesc Health 2019; 65:315-322. [PMID: 31227388 PMCID: PMC8130220 DOI: 10.1016/j.jadohealth.2019.03.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 11/28/2022]
Abstract
Confidentiality protections are a key component of high-quality adolescent sexual and reproductive health (SRH) care. Research has shown that adolescents value confidentiality and are more likely to seek care and provide honest information when confidentiality protections are implemented. However, many adolescents do not receive confidential SRH care. We synthesize studies of adolescents, parents, and providers to identify confidentiality-related factors that may explain why adolescents do not seek care or receive confidential services when they do access care. We present themes relevant to each population that address individual-level knowledge, attitudes, and behaviors, as well as clinic-level characteristics such as protocols, billing mechanisms, and clinic type. These findings have the potential to inform intervention efforts to improve the delivery of confidential SRH care for young people.
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Affiliation(s)
- Sanjana Pampati
- Oak Ridge Institute for Science and Education (ORISE), Atlanta, Georgia.
| | - Nicole Liddon
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia J Dittus
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan Hocevar Adkins
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Riley J Steiner
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mohanty S, Buttenheim AM, Joyce CM, Howa AC, Salmon D, Omer SB. Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California. Pediatrics 2018; 142:peds.2018-1051. [PMID: 30373910 PMCID: PMC6314187 DOI: 10.1542/peds.2018-1051] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/24/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5804909532001PEDS-VA_2018-1051Video Abstract OBJECTIVES: In 2015, California passed Senate Bill 227 (SB277), eliminating nonmedical vaccine exemptions for school entry. Our objective for this study was to describe the experiences of health officers and immunization staff addressing medical exemption requests under SB277. METHODS We conducted semistructured telephone interviews between August 2017 and September 2017 with health officers and immunization staff from local health jurisdictions in California. Interviews were recorded, transcribed, and analyzed for key themes. RESULTS We conducted 34 interviews with 40 health officers and immunization staff representing 35 of the 61 local health jurisdictions in California. Four main themes emerged related to experiences with medical exemptions: (1) the role of stakeholders, (2) reviewing medical exemptions received by schools, (3) medical exemptions that were perceived as problematic, and (4) frustration and concern over medical exemptions. Generally, local health jurisdictions described a narrow role in providing support and technical assistance to schools. Only 5 jurisdictions actively tracked medical exemptions received by schools, with 1 jurisdiction facing a lawsuit as a result. Examples were provided of medical exemptions that listed family history of allergies and autoimmune diseases as contraindications for immunization and of physicians charging steep fees for medical exemptions. Participants also reported concerns about the increase in medical exemptions after the implementation of SB277. CONCLUSIONS Participants reported many challenges and concerns with medical exemptions under SB277. Without additional legal changes, including a standardized review of medical exemptions, some physicians may continue to write medical exemptions for vaccine-hesitant parents, potentially limiting the long-term impact of SB277.
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Affiliation(s)
- Salini Mohanty
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania;
| | - Alison M. Buttenheim
- Department of Family and Community Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania;,Center for Health Incentives and Behavioral
Economics, Perelman School of Medicine, University of Pennsylvania,
Philadelphia, Pennsylvania
| | - Caroline M. Joyce
- Department of Family and Community Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | | | - Daniel Salmon
- Department of International Health and Health
Behavior Society, Bloomberg School of Public Health, Johns Hopkins University,
Baltimore, Maryland
| | - Saad B. Omer
- Hubert Department of Global Health and,Department of Epidemiology, Rollins School of Public
Health;,Department of Pediatrics, School of Medicine;
and,Emory Vaccine Center, Emory University, Atlanta,
Georgia
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Colaneri N, Keim SA, Adesman A. Physician Training and Qualification to Educate Patients on Attention-Deficit/Hyperactivity Disorder Stimulant Diversion and Misuse. J Child Adolesc Psychopharmacol 2018; 28:554-561. [PMID: 30124331 DOI: 10.1089/cap.2017.0066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The increased number of adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) in recent years has raised concerns regarding diversion and misuse of prescription stimulant medications. As prescribers of these medications, physicians must be prepared to educate patients on these issues. This is the first study to evaluate physician training and qualification to educate adolescent patients on stimulant diversion and misuse. METHODS A questionnaire was developed and mailed to a national sample of child and adolescent psychiatrists (CAPs), child neurologists (CNs), and developmental-behavioral pediatricians (DBPs) in the United States. In addition to descriptive statistics, multivariable regressions (log-binomial and ordinal logistic) were performed to identify differences between subspecialists. RESULTS The final sample consisted of 826 physicians who currently prescribe stimulants. Only 48% of physicians reported receiving formal training on prescription drug diversion (PDD) in medical school, residency, and/or fellowship. Twenty five percent and 48% of physicians felt inadequately qualified to educate patients on the health and legal consequences, respectively, of stimulant misuse and diversion. CAPs were more likely to have received formal training and felt better qualified to educate patients than CNs and DBPs. Physicians who received formal training were 2.4 times more likely to feel adequately qualified to educate patients on these issues. Only 58% of physicians correctly answered a legal question relating to stimulant diversion. CONCLUSIONS Most physicians have not received formal training on PDD and many feel inadequately qualified to educate patients on the health and legal consequences of stimulant misuse and diversion. Increased training is needed so physicians can effectively educate patients with ADHD.
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Affiliation(s)
- Natalie Colaneri
- 1 Division of Developmental and Behavioral Pediatrics, Cohen Children's Medical Center , New Hyde Park, New York
| | - Sarah A Keim
- 2 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital , Columbus, Ohio.,3 Department of Pediatrics, Ohio State University College of Medicine , Columbus, Ohio.,4 Department of Epidemiology, Ohio State University College of Public Health , Columbus, Ohio
| | - Andrew Adesman
- 1 Division of Developmental and Behavioral Pediatrics, Cohen Children's Medical Center , New Hyde Park, New York.,5 Donald and Barbara Zucker School of Medicine at Hofstra/Northwell , Hempstead, New York
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Gilbert AL, McCord AL, Ouyang F, Etter DJ, Williams RL, Hall JA, Tu W, Downs SM, Aalsma MC. Characteristics Associated with Confidential Consultation for Adolescents in Primary Care. J Pediatr 2018; 199:79-84.e1. [PMID: 29631769 PMCID: PMC6063778 DOI: 10.1016/j.jpeds.2018.02.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 01/15/2018] [Accepted: 02/14/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. STUDY DESIGN This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. RESULTS The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52% female; 60% black; 50% early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90%. For those seen by general pediatric providers, confidential consultation was provided to 53%. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. CONCLUSIONS Provider training is needed to reinforce the importance of confidential consultation for all adolescents.
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Affiliation(s)
- Amy Lewis Gilbert
- Indiana University School of Medicine, Department of Pediatrics, Children’s Health Services Research Section, Indianapolis, IN, USA,Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | | - Fangqian Ouyang
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Dillon J. Etter
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
| | - Rebekah L. Williams
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
| | - James A. Hall
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics, Indianapolis, IN, USA
| | - Stephen M. Downs
- Indiana University School of Medicine, Department of Pediatrics, Children’s Health Services Research Section, Indianapolis, IN, USA
| | - Matthew C. Aalsma
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Medicine Section, Indianapolis, IN, USA
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Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients. J Pediatr Adolesc Gynecol 2017; 30:76-81. [PMID: 27543001 DOI: 10.1016/j.jpag.2016.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/27/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE Providing adolescents with confidential health care results in better social and health outcomes. We sought to assess if a medical board Maintenance of Certification Part IV project could improve the delivery of confidential care to minor adolescent patients seen in outpatient primary care practices. DESIGN Participating physicians reviewed 3 months of charts for patients ages 12-17 years seen for well visits during a baseline time period, and after 2 Plan, Do, Study, Act intervention cycles to assess if they had met confidentiality standards. Participating physicians additionally completed an assessment tool on personal and clinic practices related to confidentiality. SETTING Nine academic and 3 private practice family medicine, pediatrics, and medicine-pediatrics sites. PARTICIPANTS Forty-four physicians. INTERVENTIONS Provider and staff deficits in knowledge of minor consent laws, resistance toward the idea of confidential care, and work flow issues around confidential screening were identified as primary barriers. Staff and provider trainings, scripts, and staff involvement in planning work flows were identified as key interventions. MAIN OUTCOME MEASURES Improvement in confidentiality standards met during minor adolescent well visits. RESULTS Participating physicians significantly increased the proportion of well visits in which they spent time alone with the patient (P = .001), explained minor consent laws (P < .001), and had the adolescent complete a confidential risk screening tool (P < .001), in addition to improving scores on their confidentiality assessment overall (P < .001). CONCLUSIONS A medical board Maintenance of Certification Part IV project is an effective way to change physician practice and improve the delivery of confidential care to minor adolescents seen for well visits.
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Riley M, Ahmed S, Reed BD, Quint EH. Physician Knowledge and Attitudes around Confidential Care for Minor Patients. J Pediatr Adolesc Gynecol 2015; 28:234-9. [PMID: 26024938 DOI: 10.1016/j.jpag.2014.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/30/2014] [Accepted: 08/13/2014] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Minor adolescent patients have a legal right to access certain medical services confidentially without parental consent or notification. We sought to assess physicians' knowledge of these laws, attitudes around the provision of confidential care to minors, and barriers to providing confidential care. DESIGN An anonymous online survey was sent to physicians in the Departments of Family Medicine, Internal Medicine-Pediatrics, Obstetrics/Gynecology, and Pediatrics at the University of Michigan. RESULTS Response rate was 40% (259/650). The majority of physicians felt comfortable addressing sexual health, mental health, and substance use with adolescent patients. On average, physicians answered just over half of the legal knowledge questions correctly (mean 56.6% ± 16.7%). The majority of physicians approved of laws allowing minors to consent for confidential care (90.8% ± 1.7% approval), while substantially fewer (45.1% ± 4.5%) approved of laws allowing parental notification of this care at the physician's discretion. Most physicians agreed that assured access to confidential care should be a right for adolescents. After taking the survey most physicians (76.6%) felt they needed additional training on confidentiality laws. The provision of confidential care to minors was perceived to be most inhibited by insurance issues, parental concerns/relationships with the family, and issues with the electronic medical record. CONCLUSIONS Physicians are comfortable discussing sensitive issues with adolescents and generally approve of minor consent laws, but lack knowledge about what services a minor can access confidentially. Further research is needed to assess best methods to educate physicians about minors' legal rights to confidential healthcare services.
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Affiliation(s)
- Margaret Riley
- Department of Family Medicine, University of Michigan, Ann Arbor, MI.
| | - Sana Ahmed
- Department of Pediatrics, University of Michigan, Ann Arbor, MI
| | - Barbara D Reed
- Department of Family Medicine, University of Michigan, Ann Arbor, MI
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Elger BS. Violations of medical confidentiality: opinions of primary care physicians. Br J Gen Pract 2009; 59:e344-52. [PMID: 19843415 PMCID: PMC2751939 DOI: 10.3399/bjgp09x472647] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 04/16/2009] [Accepted: 07/14/2009] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Physicians should be able to distinguish situations where they need to protect confidentiality from those where they could be obligated to reveal information. Data are scarce concerning physician's attitudes in daily situations where violations of confidentiality are avoidable. Physicians should be aware of situations where patients are identifiable. AIM To solicit participation of primary care physicians in a teaching intervention and to explore participants' opinions on violations of confidentiality. DESIGN OF STUDY A questionnaire presented seven vignettes describing avoidable violations of confidentiality (for example, without patient consent a physician mentions a politician's illness their spouse). Participants answered on a scale of 0-3 (0=no violation and 3=serious violation). All contacted physicians were invited to a teaching session during which the study results were discussed. METHOD Three-hundred and seventy-eight members of the Association of Physicians in Geneva (community physicians) working in primary care medicine, and 130 GPs and internists working at the University Hospital of Geneva (hospital physicians) took part. Physicians' answers were compared to responses from Swiss, UK, and other European law professors, and from 311 medical and law students in Geneva. RESULTS Between 4% (case 6) and 57% (case 2), of physicians thought that no violation occurred. Law professors attributed the scores to each case as 3, 3, 2, 3, 2, 3, 3; the means of physicians were: 1.9, 1.4, 0.7, 1.4 (hospital physicians)/1.9 (community physicians), 0.4, 1.6, 2.6. In most cases, physicians' and students' answers were similar. A significantly higher percentage of community physicians than hospital physicians and students thought that a physician violates confidentiality if they provide the list of their patients to the police for the investigation of the theft of a purse in the waiting room. CONCLUSION Physicians need to be fully aware of their obligations towards patient confidentiality. Avoidable breaches of confidentiality occur when colleagues and authorities (such as police and those in a judicial context) ask for information.
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Affiliation(s)
- Bernice S Elger
- Center for Legal Medicine, University of Geneva, Geneva, Switzerland.
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Abstract
PURPOSE OF REVIEW This study reviews the healthcare-related rationale for providing confidential care to adolescents, as well as the legal framework for the provision of such care. RECENT FINDINGS Physician assurances of confidentiality increase adolescents' willingness to disclose sensitive health information, but these assurances are rarely given. Physicians may not be aware of legal minor consent guidelines or may be concerned about parental reaction to such confidential discussions. Fortunately, many parents and teens understand the importance of confidential healthcare. Adolescent consent and confidentiality laws vary from state to state, but there are federal guidelines and common law concepts that are applicable throughout the United States. The Health Insurance Portability and Accountability Act Privacy Rule also provides guidelines for confidential care to minors. Future challenges for adolescent confidentiality include ease of access to electronic medical records as well as patient (and/or parent)-controlled health records. SUMMARY Confidentiality for adolescents has important implications for the quality provision of healthcare for this vulnerable population. Physicians and other healthcare providers must be aware of these health implications, as well as federal policies, common law, and their individual state's laws pertaining to this important topic.
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Lerand SJ. Teach the teacher: adolescent confidentiality and minor's consent. J Pediatr Adolesc Gynecol 2007; 20:377-80. [PMID: 18082861 DOI: 10.1016/j.jpag.2007.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 06/25/2007] [Accepted: 07/02/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Sarah J Lerand
- Department of Pediatrics, Division of Adolescent Health, Children's Hospital of Wisconsin, Childen's Corporate Center, Milwaukee, Wisconsin 53201-1997, USA.
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Lee BY, Tsai AG, Turner BJ. Medical student, medicine resident, and attending physician knowledge of the Medicare Prescription Drug Modernization and Improvement Act of 2003. TEACHING AND LEARNING IN MEDICINE 2007; 19:91-4. [PMID: 17564534 DOI: 10.1080/10401330701332052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND The Medicare Prescription Drug Modernization and Improvement Act of 2003 (MMA) will undoubtedly influence health care delivery and affect how physicians practice medicine in the United States. PURPOSE To evaluate the extent to which medical students, medicine residents, and physicians are informed about key provisions of the MMA. METHODS Eighty-four attending physicians, 104 medicine residents, and 115 fourth-year medical students at the University of Pennsylvania were surveyed over a 2-week period in February-March 2004. The brief survey instrument consisted of 10 multiple choice questions: 9 questions assessing how well-informed respondents were about the MMA and 1 question assessing their knowledge of general current events. RESULTS Most respondents (77.8%) either "strongly disagreed" or "disagreed" that they were adequately informed about the MMA. While more than half of all respondents correctly answered the two questions about drug importation from Canada and general current events, a majority did not provide the correct answer to each of the other questions. No significant differences appeared by training. CONCLUSIONS Attending physicians, medicine residents, and medical students at the University of Pennsylvania were generally ill informed about the MMA. Physician ignorance about important health care legislation continues to be a significant problem. More effective means of educating and informing medical students and physicians at all levels of training about important health policy changes may be warranted.
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Affiliation(s)
- Bruce Y Lee
- Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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Eisenberg ME, Sieving RE, Bearinger LH, Swain C, Resnick MD. Parents’ Communication with Adolescents About Sexual Behavior: A Missed Opportunity for Prevention? J Youth Adolesc 2006. [DOI: 10.1007/s10964-006-9093-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Loertscher L, Simmons PS. Adolescents' knowledge of and attitudes toward Minnesota laws concerning adolescent medical care. J Pediatr Adolesc Gynecol 2006; 19:205-7. [PMID: 16731414 DOI: 10.1016/j.jpag.2006.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Healthcare delivery to adolescents involves consent to care, confidentiality, and reimbursement in attendance to patients' medical problems. State laws address the medical care of minors with respect to privacy and autonomy. This study was conducted to determine adolescents' knowledge and attitudes toward the laws in their state, Minnesota, that influence their medical care. This information may guide health care providers in their education of adolescent patients, as well as advise future legislation on the healthcare of minors. METHODS Written questionnaires were administered to 636 9(th) through 12(th) grade students in required classes at the three public high schools in Rochester, MN, providing a representative sample of approximately fifty participants from each of the four grades. Results from the sixteen-question, anonymous survey were compiled to calculate an overall median knowledge score. Median scores were also reported by individual question, policy category, gender, grade, and socioeconomic status. Adolescent opinion was scored on a system in which +1 signified a "good law," 0 "neither a good nor bad law," and -1 a "bad law." These opinion scores were used to determine adolescents' attitudes by category as well as an overall positive, negative, or neutral opinion toward the laws. RESULTS 594(93.4%) students returned surveys. Adolescents obtained a median score of 31.3% (range, 0-100%) correct on a knowledge test. Opinion score was positive, with a median of + 0.38. 81.1% of adolescents reported that the laws in the survey had no effect on their lives. CONCLUSIONS These results indicate that adolescents are not knowledgeable of Minnesota laws regarding their medical care. Overall opinion of the existing laws is positive, particularly of those laws that protect minor consent. Most adolescents feel that these laws have not affected their lives. Low knowledge and a lack of a sense of impact from these laws indicate a need for clinicians to educate patients and their families about the legal aspects of adolescent medical care. These results are particularly relevant at a time when changes to current minor health care legislation are under consideration.
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Affiliation(s)
- L Loertscher
- Mayo Medical School, Mayo Clinic, Rochester, MN 55905, USA
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