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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics 2024; 153:e2024066326. [PMID: 38646690 DOI: 10.1542/peds.2024-066326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is an essential component of high-quality health care for adolescents and young adults and can have an impact on the health care experiences and health outcomes of youth. Federal and state laws, professional guidelines, and ethical standards provide a core framework for guidance in the implementation of confidentiality protections in clinical practice. This policy statement provides recommendations for pediatricians and other pediatric health care professionals, clinics, health systems, payers, and electronic health record developers to optimize confidentiality practices and protections for adolescents and young adults across the spectrum of care.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Hocking JS, Watson C, Chondros P, Sawyer SM, Ride J, Temple-Smith M, Boyle D, Skinner R, Patton GC, Lim MSC, Pirkis J, Johnson C, Newton S, Wardley A, Blashki G, Guy R, Dalziel K, Sanci L. Will a fee-for-service payment for a young people's health assessment in general practice increase the detection of health risk behaviours and health conditions? Protocol for a cluster randomised controlled trial (RAd Health Trial). BMJ Open 2023; 13:e074154. [PMID: 37586870 PMCID: PMC10432627 DOI: 10.1136/bmjopen-2023-074154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Adolescence is a period of major transition in physical, cognitive, social and emotional development, and the peak time for the onset of mental health conditions, substance use disorders and sexual and reproductive health risks. Prevention and treatment during this time can improve health and well-being now and into the future. However, despite clinical guidelines recommending annual preventive health assessments for young people, health professionals cite lack of consultation time and adequate funding as key barriers. This trial aims to determine whether a specific fee-for-service ('rebate payment') for a young person's health assessment, is effective and cost-effective at increasing the detection and management of health risk behaviours and conditions among young people. METHODS AND ANALYSIS This cluster randomised controlled trial will be conducted in Australian general practice. 42 general practices (clusters) will be randomly allocated 1:1 to either an intervention arm where general practitioners receive a rebate payment for each annual health assessment undertaken for 14-24-year-olds during a 2 year study period, or a control arm (no rebate). The rebate amount will be based on the Medical Benefits Schedule (Australia's list of health professional services subsidised by the Australian Government) currently available for similar age-based assessments. Our primary outcome will be the annual rate of risk behaviours and health conditions recorded in the patient electronic health record (eg, alcohol/drug use, sexual activity and mental health issues). Secondary outcomes include the annual rate of patient management activities related to health risks and conditions identified (eg, contraception prescribed, sexually transmitted infection tests ordered). A process evaluation will assess acceptability, adoption, fidelity and sustainability of the rebate; an economic evaluation will assess its cost-effectiveness. Analyses will be intention-to-treat. ETHICS AND DISSEMINATION Ethics approval has been obtained from University of Melbourne Human and Research Ethics Committee (2022-23435-29990-3). Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622000114741.
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Affiliation(s)
- Jane S Hocking
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cathy Watson
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jemimah Ride
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
- Health Economics Group, Monash University, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Skinner
- University of Sydney, Sydney, New South Wales, Australia
| | - George C Patton
- Centre for Adolescent Health, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Megan S C Lim
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Caroline Johnson
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sara Newton
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia Wardley
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant Blashki
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Guy
- Sexual Health Program, The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Kim Dalziel
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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Mazurek MO, Sadikova E, Cheak-Zamora N, Hardin A, Sohl K, Malow BA. Health Care Needs, Experiences, and Perspectives of Autistic Adults. AUTISM IN ADULTHOOD 2023; 5:51-62. [PMID: 36941853 PMCID: PMC10024270 DOI: 10.1089/aut.2021.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Autistic adults have high rates of co-occurring health conditions, suicide, and premature mortality, yet often experience health care barriers and poor health outcomes. A better understanding of the health care needs and experiences of autistic adults is essential for improving the health care system and patient experience. Methods This study examined the perspectives of autistic adults regarding their health care experiences in primary care and other settings and their suggestions for improvement using both qualitative and quantitative methods. Twenty autistic adults (aged 18-35 years, 65% male) completed surveys and individual semi-structured interviews. Results Qualitative data analysis results revealed 10 subthemes across 3 overarching themes: (1) system- and clinic-level factors affect access to care, (2) aspects of the clinic environment affect health care experiences, and (3) provider knowledge and practices affect health care experiences. Within the first theme, participants described barriers to obtaining services, including scheduling logistics, costs and inadequate insurance coverage, and transportation barriers. The second theme focused on aspects of the clinic environment that participants found especially relevant to their health care experiences and that required specific accommodations. This included sensory input, anxiety-provoking situations and procedures, and wait time. Within the third theme, participants emphasized aspects of providers' care that affected their health care experiences. Key factors included provider knowledge about autism, communication, rapport, and individualized care and patient-provider partnerships. Conclusion Overall, the findings point to a need for provider training and improvements to the health care delivery system to better meet the unique needs of autistic adults.
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Affiliation(s)
- Micah O. Mazurek
- Department of Human Services, School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | - Eleonora Sadikova
- Department of Human Services, School of Education and Human Development, University of Virginia, Charlottesville, Virginia, USA
| | - Nancy Cheak-Zamora
- Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - Amber Hardin
- Supporting Transformative Autism Research (STAR) Initiative, University of Virginia, Charlottesville, Virginia, USA
| | - Kristin Sohl
- Department of Child Health, University of Missouri, Columbia, Missouri, USA
| | - Beth A. Malow
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Adu J, Oudshoorn A, Van Berkum A, Pervez R, Norman R, Canas E, Virdee M, Yosieph L, MacDougall AG. Review: System transformation to enhance transitional age youth mental health - a scoping review. Child Adolesc Ment Health 2022; 27:399-418. [PMID: 35920392 DOI: 10.1111/camh.12592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Youth mental health challenges are an emerging and persistent global public health issue despite efforts for improvement. As part of a broader social innovation study to transform youth mental health systems, this scoping review assesses interventions that aim for systems-level changes to improve the mental well-being of transitional age youth (TAY) (15-25 years) in high-income countries. METHODS The scoping review method of Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) was used. Seven health and social service databases were utilized with study inclusion criteria applied. Titles and abstracts were screened by two independent reviewers, and four members of the research team were involved in the review and thematic analysis of selected studies. RESULTS A total of 5652 peer-reviewed articles were screened at the title and abstract level, of which 65 were assessed in full for eligibility, and 29 were included for final analysis. The peer-reviewed articles and gray literature were based in seven different high-income countries and published between 2008 and 2019. Four major themes to support youth mental health were identified in the literature: (a) improving transitions from youth to adult mental healthcare services; (b) moving care from institutions to the community; (c) general empowerment of youth in society; and (d) youth voice within the system. Inconsistent or limited systems-level approaches to TAY mental health care were noted. CONCLUSIONS There remains a need for innovative, evidence-based approaches to improve TAY mental health care.
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Affiliation(s)
- Joseph Adu
- Department of Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Abe Oudshoorn
- School of Nursing, Western University, London, ON, Canada
| | - Amy Van Berkum
- School of Nursing, Western University, London, ON, Canada
| | - Romaisa Pervez
- Mental Health Care, Parkwood Institute Research, London, ON, Canada
| | - Ross Norman
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Eugenia Canas
- Faculty of Information and Media Studies, Western University, London, ON, Canada
| | | | - Lily Yosieph
- Mental Health Care, Parkwood Institute Research, London, ON, Canada
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Wesevich A, Jiao MG, Santanam TS, Chung RJ, Uchitel J, Zhang Q, Brindis CD, Ford CA, Counts NZ, Wong CA. Adolescent and Young Adult Perspectives on Quality and Value in Health Care. Acad Pediatr 2022; 23:782-789. [PMID: 36288750 DOI: 10.1016/j.acap.2022.10.010] [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] [Received: 06/26/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe adolescent and young adult (AYA) perspectives on defining quality and value in health care and to gain understanding of their knowledge of value-based payment. METHODS A text message-based survey was sent to a convenience sample of AYAs aged 14 to 24 in 2019. Participants were asked 4 open-ended questions: 1) how they would define "good health care," 2) what factors to consider in rating doctors, 3) whose opinions should matter most when rating doctors, and 4) the best ways to collect AYA opinions on doctors, and one yes/no question on their awareness of value-based payment. Analyses included descriptive demographic statistics and an inductive thematic approach with multivariable models comparing adolescent (14-18) and young adult (19-24) responses. RESULTS Response rate was 61.0% (782/1283). Most participants were White (63.3%), female (53.3%), and adolescents (55.6%). Common themes from the first 2 questions included accessibility (specifically affordability), coverage benefits, and care experience (including compassion, respect, and clinical competence). Young adults more commonly mentioned affordability than adolescents (54.4% vs 43.3%, P = .001) and more commonly felt their opinion should matter more than their parents when rating doctors (80.6% vs 62.0%, P < .001). Only 21.0% of AYAs were familiar with the potential value-based link between physician payment and care quality. CONCLUSIONS When considering quality and value in health care, AYAs expressed their desired agency in rating the quality of their care and clinicians. AYAs' perspectives on health care quality, including the importance of care accessibility and affordability, should be considered when designing youth-centered care delivery and value-based payment models.
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Affiliation(s)
- Austin Wesevich
- Section of Hematology/Oncology, Department of Medicine, University of Chicago (A Wesevich), Chicago, Ill; Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Megan G Jiao
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Taruni S Santanam
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Richard J Chung
- Department of Medicine, Department of Pediatrics, Duke University School of Medicine (A Wesevich and RJ Chung), Durham, NC
| | - Julie Uchitel
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Qintian Zhang
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC
| | - Claire D Brindis
- Adolescent and Young Adult National Health Information Center and Philip R. Lee Institute for Health Policy Studies, University of California (CD Brindis), San Francisco, Calif
| | - Carol A Ford
- Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and the Children's Hospital of Philadelphia (CA Ford), Philadelphia, Pa
| | | | - Charlene A Wong
- Duke-Margolis Center for Health Policy, Duke University (MG Jiao, TS Santanam, J Uchitel, Q Zhang, and CA Wong), Durham, NC.
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Camenga DR, Hammer LD. Improving Substance Use Prevention, Assessment, and Treatment Financing to Enhance Equity and Improve Outcomes Among Children, Adolescents, and Young Adults. Pediatrics 2022; 150:188344. [PMID: 35757960 DOI: 10.1542/peds.2022-057992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Access to timely prevention and treatment services remains challenging for many children, adolescents, young adults, and families affected by substance use. The American Academy of Pediatrics recognizes the scope and urgency of this problem and has developed this policy statement for consideration by Congress, federal and state policy makers, and public and private payers. This policy statement updates the 2001 policy statement "Improving Substance Abuse Prevention, Assessment, and Treatment Financing for Children and Adolescents" and provides recommendations for financing substance use prevention, assessment, and treatment of children, adolescents, and young adults.
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Affiliation(s)
- Deepa R Camenga
- Department of Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut.,Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Lawrence D Hammer
- Department of Pediatrics, Stanford University School of Medicine, Stanford University, Stanford, California
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Hsu KK, Rakhmanina NY. Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics 2022; 149:183848. [PMID: 34972226 PMCID: PMC9645702 DOI: 10.1542/peds.2021-055207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.
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Affiliation(s)
- Katherine K Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts,Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts,Address correspondence to Katherine K. Hsu, MD, MPH, FAAP. E-mail:
| | - Natella Yurievna Rakhmanina
- Children’s National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, DC,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
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Hornberger LL, Lane MA. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics 2021; 147:peds.2020-040279. [PMID: 33386343 DOI: 10.1542/peds.2020-040279] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Eating disorders are serious, potentially life-threatening illnesses afflicting individuals through the life span, with a particular impact on both the physical and psychological development of children and adolescents. Because care for children and adolescents with eating disorders can be complex and resources for the treatment of eating disorders are often limited, pediatricians may be called on to not only provide medical supervision for their patients with diagnosed eating disorders but also coordinate care and advocate for appropriate services. This clinical report includes a review of common eating disorders diagnosed in children and adolescents, outlines the medical evaluation of patients suspected of having an eating disorder, presents an overview of treatment strategies, and highlights opportunities for advocacy.
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Affiliation(s)
- Laurie L Hornberger
- Division of Adolescent Medicine, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Margo A Lane
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba
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Grubb LK, Powers M. Emerging Issues in Male Adolescent Sexual and Reproductive Health Care. Pediatrics 2020; 145:peds.2020-0627. [PMID: 32341182 DOI: 10.1542/peds.2020-0627] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatricians are encouraged to address male adolescent sexual and reproductive health on a regular basis, including taking a sexual history, discussing healthy sexuality, performing an appropriate physical examination, providing patient-centered and age-appropriate anticipatory guidance, and administering appropriate vaccinations. These services can be provided to male adolescent patients in a confidential and culturally appropriate manner, can promote healthy sexual relationships and responsibility, can and involve parents in age-appropriate discussions about sexual health.
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Affiliation(s)
- Laura K Grubb
- Departments of Adolescent Medicine, Pediatrics, and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts; and
| | - Makia Powers
- Departments of Pediatrics and Public Health and Community Medicine, Morehouse School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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