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Kahn NF, Katzman K, Danzo S, McCarty CA, Richardson LP, Ford CA. Triadic Collaboration Between Adolescents, Caregivers, and Health-Care Providers to Promote Healthy Behavior. J Adolesc Health 2024; 74:358-366. [PMID: 37855752 DOI: 10.1016/j.jadohealth.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To further elucidate the various aspects of the triadic relationship between health-care providers (HCP), adolescents, and caregivers during adolescent health-care visits, with the goal of helping HCPs better understand how they can best support adolescents to choose healthy behaviors. METHODS Adolescents (ages 13-18 years) and caregivers of adolescents were recruited to participate in qualitative interviews regarding preferences for provider interactions around health behavior change. Data analysis was conducted using inductive thematic analysis to identify and describe patterns of themes across the dataset. RESULTS Thirty one adolescents and 30 caregivers participated. Fourteen themes emerged in the analysis regarding adolescent and caregiver preferences for direct and indirect relationships between adolescents, caregivers, and HCPs in promoting healthy behavior. These themes were organized into a triadic collaboration framework to promote healthy behavior using an adolescent-centered and caregiver-involved approach. DISCUSSION This study supports findings of previous research on triadic interactions between HCPs, adolescents, and caregivers while deepening our understanding of the HCP's role in helping adolescents to choose healthy behaviors. These themes are representative of the continuing shift toward an adolescent-centered and caregiver-involved approach to adolescent health care and provide further guidance to HCPs on how to work collaboratively with both adolescents and caregivers to promote healthy behaviors and improve health outcomes.
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Affiliation(s)
- Nicole F Kahn
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Sarah Danzo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Carol A Ford
- Depatment of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Ilori OR, Olarewaju SO, Awodutire PO, Ilori OS, Bamidele JO. Expectations and experiences of urban and rural in-school adolescents of adolescent reproductive health services in oyo state, Nigeria. J Public Health Afr 2023; 14:2235. [PMID: 38269106 PMCID: PMC10807364 DOI: 10.4081/jphia.2024.2235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Reproductive health information and services are fundamental to health, well-being and opportunities for women and young people, yet throughout the world, women and youths do not have access to quality reproductive health care thereby exposing them to unplanned pregnancy, teen birth, induced abortion as well as increased exposure to sexually transmitted diseases, HIV inclusive. This study is meant to explore the expectation of adolescents of an adolescent reproductive health services as well as to assess the experiences of those who had visited an ARHS at the centers. It was a descriptive cross-sectional prospective study, analytic in design using a multistage sampling technique where 452 secondary school pupils in both rural and urban communities were interviewed using a pretested validated questionnaire. Data was analyzed using SPSS version 21. Chi square was used to test for association between both rural and urban adolescents in issues relating to their expectation and experiences, with P-value of #x003C;0.05. More of the respondents in the urban communities (73,32.4%) have the expectation that Adolescent Reproductive Health Services (ARHS) should be provided in an existing health service with special attention to adolescents while a larger percentage of those who preferred a special adolescent health institution were from the rural communities (122, 54.2%) which was statistically significant with a P-value of 0.001. More of respondents from the rural communities also expect that contraception services should be provided in an ARHS center while life skill services are expected by more of the respondents from the urban communities (122, 55.6%). More of the rural community respondents (57,25.3%) expect that fee at the ARHS centers should be provided at a subsidized rate while more of the urban dwellers have the expectation that services provided should be free of charge. For respondents who had been to an ARHS center, more of the urban respondents were attended to by a Medical doctor and a large percentage (34, 94.4%) of those who had visited ARHS center before professed to be satisfied with the services rendered there. Expectations from adolescents from ARHS are very high. However, most of them prefer a free of charge service as well as a service area nearer to residential area. Confidentiality and having a young health professional at the service centers cannot be overemphasized in the provision of quality ARHS.
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Ybarra A, Wong C, Gribbons M, DeSilva N, Jetelina K, Rosenthal SL, Francis JKR. Attitudes about the Provision of Sexual Health Services in an Inpatient Setting. J Pediatr Adolesc Gynecol 2023; 36:525-531. [PMID: 37453668 DOI: 10.1016/j.jpag.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/13/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE To examine the relationship between clinicians' attitudes about the appropriateness of providing sexual health services in the inpatient setting and confidence in providing services METHODS: An online survey was emailed to pediatric hospitalists, adolescent medicine, and pediatric and adolescent gynecology societies and directors. Confidence in managing 8 sexual health situations was measured on a 4-point Likert scale, summed, averaged, and dichotomized into confident and not so confident. Participants were asked to rate on a 5-point Likert scale their belief that providing sexual health services in the inpatient setting would be appropriate. An adjusted, multivariate logistic regression identified associations between participant demographic characteristics, professional characteristics, and confidence and attitudes about the appropriateness of providing inpatient sexual health services. RESULTS Among the 610 participants, the mean age was 40 years. Most were females (79%), non-Hispanic White (71%), and practiced pediatric hospital/general medicine (73%). Most (73%) were not so confident across all 8 confidence items. Overall, 61% "strongly agreed" that providing sexual health services in the inpatient setting was appropriate. Participants who reported younger age, being female, and confidence in providing services were significantly associated with strong agreement that it was appropriate to provide sexual health services in the inpatient setting. Those who identified as Christian non-Catholic were significantly less likely to report strong agreement. CONCLUSION Most providers strongly agreed that providing sexual health services in the inpatient setting was appropriate, yet most were not so confident in managing sexual health situations. Future studies should focus on addressing concerns and barriers to providing sexual health services.
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Affiliation(s)
- Abby Ybarra
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Catherine Wong
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Megan Gribbons
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health System of Texas, Dallas, Texas
| | - Nirupama DeSilva
- Children's Health System of Texas, Dallas, Texas; Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katelyn Jetelina
- Department of Population Health Analytics, Meadow Mental Health Policy Institute, Dallas, Texas
| | - Susan L Rosenthal
- Department of Pediatrics and Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Columbia, New York
| | - Jenny K R Francis
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas; Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas; Children's Health System of Texas, Dallas, Texas.
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4
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Ilori OR, Olarewaju SO, Awodutire PO, Ilori OS, Bamidele JO. Expectations and experiences of urban and rural in-school adolescents of adolescent reproductive health services in Oyo State. J Public Health Afr 2023; 14:2211. [PMID: 38162333 PMCID: PMC10755511 DOI: 10.4081/jphia.2023.2211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/26/2022] [Indexed: 01/03/2024] Open
Abstract
Reproductive health information and services are fundamental to health, well-being and opportunities for women and young people, yet throughout the world, women and youths do not have access to quality reproductive health care thereby exposing them to unplanned pregnancy, teen birth, induced abortion as well as increased exposure to sexually transmitted diseases, HIV inclusive. This study is meant to explore the expectation of adolescents of an adolescent reproductive health services as well as to assess the experiences of those who had visited an ARHS at the centers. It was a descriptive cross-sectional prospective study, analytic in design using a multistage sampling technique where 452 secondary school pupils in both rural and urban communities were interviewed using a pretested validated questionnaire. Data was analyzed using SPSS version 21. Chi square was used to test for association between both rural and urban adolescents in issues relating to their expectation and experiences, with P-value of <0.05. More of the respondents in the urban communities (73,32.4%) have the expectation that Adolescent Reproductive Health Services (ARHS) should be provided in an existing health service with special attention to adolescents while a larger percentage of those who preferred a special adolescent health institution were from the rural communities (122, 54.2%) which was statistically significant with a P-value of 0.001. More of respondents from the rural communities also expect that contraception services should be provided in an ARHS center while life skill services are expected by more of the respondents from the urban communities (122, 55.6%). More of the rural community respondents (57,25.3%) expect that fee at the ARHS centers should be provided at a subsidized rate while more of the urban dwellers have the expectation that services provided should be free of charge. For respondents who had been to an ARHS center, more of the urban respondents were attended to by a Medical doctor and a large percentage (34, 94.4%) of those who had visited ARHS center before professed to be satisfied with the services rendered there. Expectations from adolescents from ARHS are very high. However, most of them prefer a free of charge service as well as a service area nearer to residential area. Confidentiality and having a young health professional at the service centers cannot be overemphasized in the provision of quality ARHS.
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Affiliation(s)
- Oluwatosin Ruth Ilori
- Department of Community Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso
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Wilson KL, Garney WR, Garcia KM, Esquivel CH, Ajayi KV, Flores SA, Curran L. The Development of a Systems-Level Approach to Address Adolescent Access to Health Care: A Novel Confidentiality Policy Intervention. FAMILY & COMMUNITY HEALTH 2023; 46:S66-S73. [PMID: 37696017 DOI: 10.1097/fch.0000000000000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Most evidence-based interventions in adolescent sexual and reproductive health and mental health remain largely aimed at individual-level outcomes and do not conceptualize adolescent health within a social-ecological model. Interventions to affect policy, systems, and environmental change offer potential for sustained population impact. The current initiative used an innovation framework to develop a novel systems-level approach to address adolescent access to health care. The Framework for Public Health Innovation provided an approach to develop a novel intervention. Confident Teen is a systems-level intervention that creates the opportunity, through organizational policy change, to increase adolescents' access to confidential sexual and reproductive health services through organizational policies. Gaps in adolescents' access to health care services allowed for a systems-level approach to be designed through an adolescent pregnancy prevention innovation initiative. Confidentiality is a right and critical component to their health care; therefore, a policy and conversation between provider and patient is a prioritized component of the novel intervention.
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Affiliation(s)
- Kelly L Wilson
- School of Public Health, Texas A&M University, College Station (Drs Garney, Esquivel, and Ajayi and Mss Garcia, Flores, and Curran); and School of Nursing, Texas A&M University, Bryan (Dr Wilson)
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Benziger CP, Suess M, Allen CI, Freitag LA, Asche SE, Ekstrom HL, Essien IJ, Muthineni A, Thirumalai V, Vo PH, Kromrey KA, Ronkainen EA, Saman DM, O'Connor PJ, Kharbanda EO. Adapting a clinical decision support system to improve identification of pediatric hypertension in a rural health system: Design of a pragmatic trial. Contemp Clin Trials 2023; 132:107293. [PMID: 37454727 PMCID: PMC11027719 DOI: 10.1016/j.cct.2023.107293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Identifying hypertension (HTN) early is crucial in preventing and lowering the long-term risk of heart disease, yet HTN in children often goes undiagnosed. An electronic health record linked, web-based clinical decision support (CDS) called PedsBP can help address this care gap and has been previously shown to increase recognition of HTN by primary care clinicians. OBJECTIVES To adapt the PedsBP tool for use in a mostly rural health system and then to evaluate the effectiveness of PedsBP for repeat of hypertensive level blood pressure (BP) measurements and HTN recognition among youth 6-17 years of age in primary care settings, comparing low-intensity and high-intensity implementation approaches. METHODS AND DESIGN PedsBP was evaluated through a pragmatic, clinic-randomized trial. The tool was piloted in 2 primary care clinics and modified prior to the full trial. Forty community-based, primary care clinics (or clusters of clinics) were randomly allocated in a 1:1:1 ratio to usual care, low-intensity implementation (CDS only), or high-intensity implementation (CDS plus in-person training, monthly use reports, and ongoing communication between study staff and clinics). Accrual of eligible patients started on August 1, 2022 and will continue for 18 months. Primary outcomes include repeating hypertensive level BP measurements at office visits and clinical recognition of HTN. Secondary outcomes include lifestyle counseling, dietician referral, and BP at follow-up. CONCLUSION This report focuses on the design and feasibility of adapting and implementing PedsBP in a rural primary care setting. The trial and analysis are ongoing with main results expected in mid-2024.
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Affiliation(s)
- Catherine P Benziger
- Essentia Health Heart and Vascular Center, Duluth, MN, United States of America.
| | - Madison Suess
- University of Minnesota Medical School, Duluth Campus, Duluth, MN, United States of America
| | - Clayton I Allen
- Essentia Institute of Rural Health, Duluth, MN, United States of America
| | - Laura A Freitag
- Essentia Institute of Rural Health, Duluth, MN, United States of America
| | - Stephen E Asche
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Heidi L Ekstrom
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Inih J Essien
- HealthPartners Institute, Bloomington, MN, United States of America
| | | | | | - Phuong H Vo
- HealthPartners Institute, Bloomington, MN, United States of America
| | - Kay A Kromrey
- HealthPartners Institute, Bloomington, MN, United States of America
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Agostino H, Toulany A. Considerations for privacy and confidentiality in adolescent health care service delivery. Paediatr Child Health 2023; 28:172-183. [PMID: 37205141 PMCID: PMC10186092 DOI: 10.1093/pch/pxac117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 06/13/2022] [Indexed: 05/21/2023] Open
Abstract
A hallmark of delivering quality adolescent health care services is the provision of confidential care. Key tenets when providing confidential care for adolescents include time alone with a health care provider, maintaining the privacy of health information, and securing informed consent for services without permission from a parent, guardian, or caregiver. While confidentiality is a basic principle for all health care encounters regardless of age, the unique considerations for capable adolescent patients are not always realized or appreciated. By ensuring appropriate quantity and quality of confidential care for adolescents, clinicians are better equipped to elicit a comprehensive history and physical examination, while empowering the adolescent involved to develop agency, autonomy, trust, and responsibility for their own health care decision-making and management.
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Affiliation(s)
- Holly Agostino
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
| | - Alene Toulany
- Canadian Paediatric Society, Adolescent Health Committee, Ottawa, Ontario, Canada
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Les considérations en matière de confidentialité et de protection de la vie privée lors de la prestation des services de santé aux adolescents. Paediatr Child Health 2023; 28:178-183. [PMCID: PMC10186098 DOI: 10.1093/pch/pxac118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
La confidentialité des soins fait partie des caractéristiques des services de santé de qualité aux adolescents. Du temps seul à seul avec le professionnel de la santé, l’accès à l’information en matière de santé réservé aux personnes autorisées et l’obtention d’un consentement éclairé avant de donner les services sans demander le consentement d’un parent, d’un tuteur ou d’un proche, font partie des fondements des soins confidentiels aux adolescents. La confidentialité est un principe fondamental qui s’applique à toutes les rencontres médicales, quel que soit l’âge, mais les considérations propres aux patients adolescents aptes ne sont pas toujours comprises ni prises en compte. S’ils donnent aux adolescents des soins confidentiels d’une quantité et d’une qualité appropriées, les cliniciens sont mieux en mesure d’obtenir une anamnèse et un examen physique complets, et ils habilitent les adolescents à développer leur capacité d’agir, leur autonomie, leur confiance et leur responsabilité à l’égard de leurs décisions en matière de santé et de la prise en charge de leurs propres soins.
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Brar P, Sieving RE, Steiner RJ, Gewirtz O'Brien JR, Moore MM, Mehus CJ, Ross C, Klein JD, Santelli J. Provider Facilitation of Parent-Adolescent Health Communication: Findings From a National Survey. J Pediatr Health Care 2023; 37:253-261. [PMID: 36624017 PMCID: PMC11034920 DOI: 10.1016/j.pedhc.2022.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Primary care providers are well-positioned to facilitate parent-adolescent health communication. We examined provider-facilitated parent-adolescent health communication prevalence and associations with parent-adolescent health communication. METHOD Using data from a national survey of parent-adolescent dyads (n = 853), we calculated the prevalence of provider-facilitated parent-adolescent health communication about 11 topics as a result of adolescent's last preventive visit. We examined correlates of of provider-facilitatedparent-adolescent communication and associations with with parent-adolescent communication. RESULTS Eighteen percent of adolescents reported that a provider helped them talk with their parent about a health concern, with little variability by adolescent, parent, or provider characteristics. Prevalence of parent-adolescent communication because of an adolescent's last preventive visit ranged between 38.4% and 79.5%. Provider facilitation was positively associated with parent-adolescent communication for all topics. DISCUSSION Given the low prevalence of provider-facilitated-parent-adolescent health communication and positive associations between provider facilitation and parent-adolescent communication about multiple important health-related topics, efforts to improve this practice could be beneficial.
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Ramfelt K, Andersson Gäre B, Andersson AC, Petersson C. 'It's like a never-ending diabetes youth camp': Co-designing a digital social network for young people with type 1 diabetes. Health Expect 2023; 26:662-669. [PMID: 36541231 PMCID: PMC10010099 DOI: 10.1111/hex.13690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/28/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Living with a chronic condition such as type 1 diabetes (T1D) affects everyday life and support from others experiencing a similar situation can be helpful. A way to receive such support is to use an online network where people can connect and share experiences. Research has described the benefits of using such tools for connecting patients. The aim of this study was to describe the co-design of a social network for young people with T1D and to describe their experiences when using this network. METHODS A co-design approach was used, following three steps adapted from Sanders and Stappers (2008). In all, 36 adolescents with T1D participated. Data in the form of recordings and notes from telephone interviews, workshops and focus groups were collected and then analysed using content analysis. Numerical data from the digital platform were also used. FINDINGS For the interpersonal values, supporting, learning and relating to emerge, the framework of the network must be appealing and user-friendly. The limits of time and place are eliminated, and there is a possibility for many more to join in. CONCLUSION Co-design ensures that what stakeholders think is important forms the basis for the design. The interpersonal values that are promoted are ones that only the exchange of lived knowledge and experience can generate. It is complementary to the support that healthcare professionals can offer; thus, this kind of social network is important for improved, coproduced care. PATIENT OR PUBLIC CONTRIBUTION The participants in the present study were persons living with T1D. They were active co-creators from the start to the end. An adult person with experience of living with T1D was involved as an advisor in the research team when drafting the manuscript.
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Affiliation(s)
- Kerstin Ramfelt
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Qulturum-Center for Learning and Innovation in Healthcare, Jönköping, Sweden
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Futurum, Jönköping, Sweden
| | - Ann-Christine Andersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Health Society and Health Science, Malmö University, Malmö, Sweden
| | - Christina Petersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden.,Qulturum-Center for Learning and Innovation in Healthcare, Jönköping, Sweden
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Masonbrink AR, Noel-MacDonnell J, Staggs VS, Stancil S, Goggin K, Miller MK. Feasibility of a Contraception Intervention for Hospitalized Adolescents and Young Adults. Hosp Pediatr 2023; 13:337-344. [PMID: 36897226 PMCID: PMC10071428 DOI: 10.1542/hpeds.2022-006996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVES Unintended pregnancy in adolescents and young adults (AYAs) is linked with negative outcomes. We sought to evaluate the feasibility, acceptability, and preliminary efficacy of a contraception intervention in the pediatric hospital. METHODS We conducted a pilot study of hospitalized AYA females aged 14 to 21 years who reported past or anticipated sexual activity. A health educator offered a tablet-based intervention to provide contraception education and medications, if desired. We assessed feasibility (ie, intervention completion, duration, disruption to care), acceptability (ie, proportion rating as acceptable or satisfactory) among AYAs, parents or guardians, and healthcare providers, as well as preliminary efficacy (eg, contraception uptake) at enrollment and 3-month follow up. RESULTS We enrolled 25 AYA participants; mean age was 16.4 ± 1.5 years. The intervention demonstrated high feasibility as all enrolled participants (n = 25, 100%) completed the intervention and median intervention duration was 32 (interquartile range 25-45) minutes. Among 11 nurses, 82% (n = 9) reported the intervention was not at all or minimally disruptive to their workflow. All AYAs were very or somewhat satisfied with the intervention and 88% (n = 7) of 8 parents and guardians surveyed felt it was acceptable for the educator to meet privately with their child. Eleven participants (44%) started hormonal contraception, most commonly the subdermal implant (n = 7, 64%), and 23 (92%) received condoms. CONCLUSIONS Our findings support the feasibility and acceptability of our contraception intervention in the pediatric hospital resulting in contraception uptake among AYAs. Efforts to expand access to contraception are important to reduce unintended pregnancy, especially as restrictions to abortion are increasing in some states.
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Affiliation(s)
- Abbey R. Masonbrink
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Janelle Noel-MacDonnell
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
- Schools of Medicine
| | - Vincent S. Staggs
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
- Schools of Medicine
| | - Stephani Stancil
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
- Schools of Medicine
| | - Kathy Goggin
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
- Schools of Medicine
- Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri
| | - Melissa K. Miller
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, Missouri
- Health Services and Outcomes Research, Children’s Mercy Kansas City, Kansas City, Missouri
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Kerolle S, Zuckerbraun N, Reed J, Pollack A, Lieberman J, Ruppert K, Hoehn E. Examining Parental Acceptance of Confidential Contraception Initiation in a Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:125-129. [PMID: 35947074 DOI: 10.1097/pec.0000000000002818] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pediatric emergency department (PED) is a valuable site for contraceptive services among adolescents at risk for pregnancy. Studies have shown that adolescents are interested in such services; however, little is known about parental opinions on contraceptive care in the PED. We aimed to (1) assess parental acceptance of confidential provisions of contraception in the PED and (2) identify facilitators/barriers to parental acceptance of contraception in this setting. METHODS This study included parents/guardians of females aged 14 to 19 years who presented to the PED with any chief complaint. Participants completed a self-administered 25-question survey based on previously validated questions to assess their acceptance of contraception provisions, both confidentially and with parental involvement, for their adolescent in the PED. χ 2 or Fisher exact tests were used to examine variables associated with parental acceptance of confidential contraception. RESULTS Of the 102 parents/guardians surveyed, most parents (58/102, 57%) were accepting of confidential contraception for their adolescent. However, more parents (82/101, 81%) were accepting of contraception in the ED with their involvement, as opposed to confidentially without their involvement. Those accepting had an increased perceived risk of their adolescent having sex or becoming pregnant (mean [SD], 13 [20]; P = 0.02; odds ratio, 1.05; 95% confidence interval, 1.00-1.09), were aware of their adolescent's rights to confidential contraception (62%; P = 0.006; odds ratio, 3.18; 95% confidence interval, 1.39-7.28), and had slightly older teens (16 vs 15.5 years, P = 0.01). More parents accepted OCPs over IUDs in the PED (53/58, 91% vs 26/57, 46%). CONCLUSIONS Although most parents were accepting of the PED provider offering confidential contraception to their adolescent, more parents preferred to be involved with decisions regarding contraception, in a collaborative approach. Further research is necessary to better elucidate parental/adolescent preferences.
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Affiliation(s)
| | | | | | - Andrea Pollack
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Julia Lieberman
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Piyathilake CJ, Badiga S, Jolly PE. Potential Effects of Age-Based Changes in Screening Guidelines on the Identification of Women at Risk for Developing Cervical Cancer. Cancer Prev Res (Phila) 2023; 16:OF1-OF10. [PMID: 36657016 PMCID: PMC10352467 DOI: 10.1158/1940-6207.capr-22-0426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/09/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
Current American Cancer Society guidelines estimated that screening starting at the age of 25 years with Pap and/or human papillomavirus (HPV) testing is sufficient to prevent cervical cancer. The effect of having HPV infections without Pap-based care until age 25 on the prevalence of higher grades of cervical intraepithelial neoplasia (≥CIN 2) and their determinants are largely unknown. The objectives of the study were to document the potential effects of age-based changes in screening guidelines on the identification of ≥CIN 2 and their determinants. The study included 1,584 women diagnosed with abnormal Pap and tested for HPVs and histologic diagnoses of cervical lesions. The association between demographic/lifestyle factors and HPV status and risk of being diagnosed with ≥CIN 2 among younger (21-<25 years) or older (≥25 year) women was tested using unconditional multiple logistic regression models. We observed that younger women who are not screened have a similar or higher risk of developing specific high-risk HPV genotype-associated ≥CIN 2 lesions compared with older women who are screened according to the current guidelines. In addition, younger women who reported live births, smoking, contraceptive use, and a higher number of sexual partners were significantly at higher risk of being diagnosed with ≥CIN 2. Targeted screening of younger women at risk for developing ≥CIN 2 will address the concern of overtreatment while providing the recommended care to those who require such care to prevent the development of cervical cancer. PREVENTION RELEVANCE This study documents the concerns of the age-based changes in screening guidelines on the identification of higher grades of cervical intraepithelial neoplasia and their determinants in women diagnosed with abnormal Pap smear and emphasize the need for targeted screening of younger women to prevent cervical cancer.
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Affiliation(s)
| | - Suguna Badiga
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL 35294
| | - Pauline E Jolly
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL 35294
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14
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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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15
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Al-Shimari F, Kahn NF, McCarty CA, Parker EO, Richardson LP, Shafii T. Provider Use of Time Alone With Adolescents: Differences by Health Concern. J Adolesc Health 2022; 71:508-511. [PMID: 35779999 PMCID: PMC10843781 DOI: 10.1016/j.jadohealth.2022.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine associations between reports of sensitive health behaviors and the provision of time alone by a clinician during adolescent well visits. METHODS Data were collected from 547 adolescents who completed a well visit at one of eight clinics. Adjusted mixed logistic regression was used to examine whether reports of sexual behavior, substance use, disordered eating, mental health concerns, and demographic characteristics were associated with time alone. RESULTS Sexual behavior was found to be significantly associated with time alone, while substance use, disordered eating, a positive depression screen, and suicidal ideation were not. Older adolescents and males were more likely to report time alone, while race/ethnicity had no association with time alone. DISCUSSION Clinicians may be prioritizing time alone for behavioral concerns differently than for other sensitive behaviors.
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Affiliation(s)
- Fatima Al-Shimari
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Nicole F Kahn
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
| | - Carolyn A McCarty
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth O Parker
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Laura P Richardson
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Taraneh Shafii
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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16
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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] [MESH Headings] [Grants] [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.
| | - 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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Gender-Based Violence in Adolescent Dating from a Medical Perspective: A Qualitative Study of the Needs Felt in Primary Healthcare Centres. Healthcare (Basel) 2021; 10:healthcare10010017. [PMID: 35052181 PMCID: PMC8775754 DOI: 10.3390/healthcare10010017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Violence in adolescent dating has become a worrying public health problem. Research carried out on the issue has focused on identifying the causes of this phenomenon. However, difficulties have been found in designing and implementing effective prevention programs. In this context, primary healthcare physicians are one of the most important figures in screening for and detecting this phenomenon, since, in many cases, they are the first to have contact with the victims. The present study focuses on the qualitative analysis of a series of interviews carried out with 95 primary healthcare physicians in Extremadura, Spain. These interviews addressed various questions related to the theoretical and practical knowledge that the physicians have about the topic. The analysis of their responses reveals some of the strengths and weaknesses of the Spanish public health system, at the same time as pointing to what is needed to be able to improve comprehensive intervention for the victims, from the moment they arrive for their first consultation until they are treated and referred to different health specialists.
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18
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Lundberg V, Eriksson C, Lind T, Coyne I, Fjellman-Wiklund A. How children with juvenile idiopathic arthritis view participation and communication in healthcare encounters: a qualitative study. Pediatr Rheumatol Online J 2021; 19:156. [PMID: 34727931 PMCID: PMC8561993 DOI: 10.1186/s12969-021-00642-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/10/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Children report that they do not participate in their healthcare as much as they want, despite having the lawful right to form their own views and the right to express those views freely in all matters affecting them. Children and parents appeared to be more satisfied when healthcare professionals (HCP) use a participatory style in healthcare encounters. AIM To explore how children, adolescents and young adults with Juvenile Idiopathic Arthritis (JIA) and parents of children with JIA view their participation and communication in healthcare encounters with healthcare professionals. METHODS Using a qualitative study design, participatory workshops were held separately for children and young adults with JIA and parents of children with JIA. The workshop data were analysed with Graneheim and Lundman's Qualitative Content Analysis resulting in one main theme and two subthemes. RESULTS The theme "Feeling alienated or familiar with healthcare encounters" illuminates how children felt alienated at healthcare encounters if they found the encounters emotionally distressing. Children could withhold information regarding their health and function from both HCPs and their family and friends. The subtheme "Distancing oneself from healthcare" describe why children felt reluctant to engage in the healthcare encounters and experienced difficulty expressing how they really felt. The subtheme "Being a normal event in life" describe how children felt more comfortable over time engaging with HCPs when they knew what would happen, and felt that HCPs gave them the necessary support they needed to participate. CONCLUSIONS Children's participation in healthcare encounters varied depending if children felt alienated or familiar to the healthcare situations. Children distance themselves and are reluctant to engage in healthcare encounters if they find them emotionally distressing and feel disregarded. Over time, children can become more familiar and at ease with healthcare situations when they feel safe and experience personal and positive encounters. When the children are prepared for the encounter, provided with the space and support they want and receive tailored help they are more enabled to participate.
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Affiliation(s)
- Veronica Lundberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87, Umeå, Sweden. .,Department of Clinical Sciences, Pediatrics, Umeå University, SE 901 85, Umeå, Sweden.
| | - Catharina Eriksson
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Pediatrics, Umeå University, SE 901 85 Umeå, Sweden ,Department of Public Health and Clinical Medicine/Rheumatology, SE 901 87 Umeå, Sweden
| | - Torbjörn Lind
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences, Pediatrics, Umeå University, SE 901 85 Umeå, Sweden
| | - Imelda Coyne
- grid.8217.c0000 0004 1936 9705School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Anncristine Fjellman-Wiklund
- grid.12650.300000 0001 1034 3451Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, SE 901 87 Umeå, Sweden
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19
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McKinlay E, Morgan S, Garrett S, Dunlop A, Pullon S. Young peoples' perspectives about care in a youth-friendly general practice. J Prim Health Care 2021; 13:157-164. [PMID: 34620297 DOI: 10.1071/hc20134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Youth health outcomes are poor in New Zealand and have a life-long impact on individuals, whānau (family) and society. Little is known about how young people view their experiences of general practice care despite it being the most common place to access health care. AIM This study sought to explore young peoples' experiences of care in a selected, youth-friendly general practice. METHODS In-depth individual interviews with six young people. RESULTS Four themes were identified from young peoples' narratives in relation to their experiences of general practice care: going to the doctor is not easy for a young person; the attributes of staff make all the difference; specific youth-friendly consultation practices help young people; and a youth-friendly physical environment can help young people access services and feel safe. DISCUSSION Even though the study general practice had explicitly instituted youth-friendly initiatives, including offering no-charge consultations and specialist staff members, young people still described considerable barriers to attendance. Many barriers are practice-based and could be modified by staff training, provision of further youth care staff roles and consideration of environmental changes. Other barriers such as waiving prescription costs need government funding.
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Affiliation(s)
- Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand; and Corresponding author.
| | - Sonya Morgan
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sue Garrett
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Abby Dunlop
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Sue Pullon
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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20
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Sieving RE, McRee AL, Mehus C, Gewirtz O'Brien JR, Wang S, Brar P, Catallozzi M, Gorzkowski J, Grilo S, Kaseeska K, Santelli J, Steiner RJ, Klein JD. Sexual and Reproductive Health Discussions During Preventive Visits. Pediatrics 2021; 148:e2020049411. [PMID: 34253569 PMCID: PMC9125413 DOI: 10.1542/peds.2020-049411] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To quantify adolescent- and parent-perceived importance of provider-adolescent discussions about sexual and reproductive health (SRH), describe prevalence of provider confidentiality practices and provider-adolescent discussions about SRH topics during preventive visits, and identify missed opportunities for such conversations. METHODS We used data from a national Internet survey of 11- to 17-year-old adolescents and their parents. Data were weighted to represent the noninstitutionalized US adolescent population. Adolescents who had a preventive visit in the past 2 years and their parents reported on perceived importance of provider-adolescent discussions about SRH topics: puberty, safe dating, gender identity, sexual orientation, sexual decision-making, sexually transmitted infections and HIV, methods of birth control, and where to get SRH services. Adolescents and parents reported whether they had ever discussed confidentiality with the adolescent's provider. Adolescents reported experiences at their most recent preventive visit, including whether a provider spoke about specific SRH topics and whether they had time alone with a provider. RESULTS A majority of adolescents and parents deemed provider-adolescent discussions about puberty, sexually transmitted infections and HIV, and birth control as important. However, fewer than one-third of adolescents reported discussions about SRH topics other than puberty at their most recent preventive visit. These discussions were particularly uncommon among younger adolescents. Within age groups, discussions about several topics varied by sex. CONCLUSIONS Although most parents and adolescents value provider-adolescent discussions of selected SRH topics, these discussions do not occur routinely during preventive visits. Preventive visits represent a missed opportunity for adolescents to receive screening, education, and guidance related to SRH.
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Affiliation(s)
| | | | - Christopher Mehus
- Center for Applied Research and Educational Improvement, College of Education and Human Development, University of Minnesota, Minneapolis, Minnesota
| | | | | | - Pooja Brar
- Department of Family Studies and Community Development, Towson University, Towson, Maryland
| | - Marina Catallozzi
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University and Columbia University Irving Medical Center, New York, New York
| | | | - Stephanie Grilo
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University and Columbia University Irving Medical Center, New York, New York
| | | | - John Santelli
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University and Columbia University Irving Medical Center, New York, New York
| | - Riley J Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago Illinois
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21
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Masonbrink AR, Hunt JA, Bhandal A, Randell KA, Mermelstein S, Wells S, Miller MK. Self-reported and Documented Substance Use Among Adolescents in the Pediatric Hospital. Pediatrics 2021; 147:e2020031468. [PMID: 33941583 PMCID: PMC8168602 DOI: 10.1542/peds.2020-031468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescent substance use is associated with numerous adverse health outcomes. A hospitalization represents an opportunity to identify and address substance use. We sought to describe self-reported and documented substance use among hospitalized adolescents. METHODS We conducted a cross-sectional survey of adolescents aged 14 to 18 years old admitted to two pediatric hospitals between August 2019 and March 2020. Using previously validated questions, we assessed the proportion of adolescents reporting ever, monthly, and weekly use of alcohol, marijuana, tobacco, electronic cigarettes, and other illicit drugs and nonmedical use of prescription medications. We reviewed medical records for substance use documentation. RESULTS Among 306 respondents, 57% were older (16-18 years old), 53% were female, and 55% were of non-Hispanic white race and ethnicity. The most frequently reported substances ever used were alcohol (39%), marijuana (33%), and electronic cigarettes (31%); 104 (34%) respondents reported ever use of >1 substance. Compared with younger adolescents, those aged 16 to 18 years were more likely to report ever use of alcohol (29% vs 46%; P = .002), marijuana (22% vs 41%; P < .001), and ≥2 drugs (26% vs 40%; P = .009). A positive substance use history was rarely documented (11% of records reviewed), and concordance between documented and self-reported substance use was also rare. CONCLUSIONS In this study of hospitalized adolescents, the most commonly reported substances used were alcohol, marijuana, and electronic cigarettes. Positive substance use documentation was rare and often discordant with self-reported substance use. Efforts to improve systematic screening for substance use and interventions for prevention and cessation in hospitalized adolescents are critically needed.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Jane Alyce Hunt
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Avleen Bhandal
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Kimberly A Randell
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Sarah Mermelstein
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Sarah Wells
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Melissa K Miller
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Missouri; and
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22
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Masonbrink A. Opportunities to Improve Sexual and Reproductive Care Among Hospitalized Adolescents. Hosp Pediatr 2020; 10:e4-e7. [PMID: 33067348 DOI: 10.1542/hpeds.2020-001008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Abbey Masonbrink
- Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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23
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Affiliation(s)
- Maria Trent
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
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24
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Sieving RE, Mehus C, Catallozzi M, Grilo S, Steiner RJ, Brar P, Gewirtz O’Brien JR, Gorzkowski J, Kaseeska K, Kelly ED, Klein JD, McRee AL, Randazzo L, Santelli J. Understanding Primary Care Providers' Perceptions and Practices in Implementing Confidential Adolescent Sexual and Reproductive Health Services. J Adolesc Health 2020; 67:569-575. [PMID: 32389456 PMCID: PMC9062682 DOI: 10.1016/j.jadohealth.2020.03.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Substantial gaps exist between professional guidelines and practice around confidential adolescent services, including private time between health-care providers and adolescents. Efforts to provide quality sexual and reproductive health services (SRHS) require an understanding of barriers and facilitators to care from the perspectives of primary care providers working with adolescents and their parents. METHODS We conducted structured qualitative interviews with a purposive sample of pediatricians, family physicians, and nurse practitioners (n = 25) from urban and rural Minnesota communities with higher and lower rates of adolescent pregnancy. Provider interviews included confidentiality beliefs and practices; SRHS screening and counseling; and referral practices. RESULTS The analysis identified two key themes: (1) individual and structural factors were related to variations in SRH screening and counseling and (2) a wide range of factors influenced provider decision-making in initiating private time. A nuanced set of factors informed SRHS provided, including provider comfort with specific topics; provider engagement and relationship with parents; use of adolescent screening tools; practices, policies, and resources within the clinic setting; and community norms including openness with communication about sex and religious considerations regarding adolescent sexuality. Factors that shaped providers' decisions in initiating private time included adolescent age, developmental stage, health behaviors and other characteristics; observed adolescent-parent interactions; parent support for private time; reason for clinic visit; laws and professional guidelines; and cultural considerations. CONCLUSIONS Findings suggest opportunities for interventions related to provider and clinic staff training, routine communication with adolescents and their parents, and clinic policies and protocols that can improve the quality of adolescent SRHS.
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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
- School of Nursing, University of Minnesota, Minneapolis, Minnesota,Institute for Translational Research in Children’s Mental 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
| | - Stephanie Grilo
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - Riley J. Steiner
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pooja Brar
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | | | - Julie Gorzkowski
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | - Kristen Kaseeska
- Department of Healthy Resilient Children Youth and Families, American Academy of Pediatrics, Itasca, Illinois
| | | | - Jonathan D. Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Lia Randazzo
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York
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25
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Lundberg V, Sandlund M, Eriksson C, Janols R, Lind T, Fjellman-Wiklund A. How children and adolescents with juvenile idiopathic arthritis participate in their healthcare: health professionals' views. Disabil Rehabil 2020; 44:1908-1915. [PMID: 32875956 DOI: 10.1080/09638288.2020.1811406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The study explores how healthcare professionals view participation of children and adolescents with juvenile idiopathic arthritis, in healthcare encounters. METHODS This qualitative study includes focus groups of HCPs from different professions. The interviews were analysed with qualitative content analysis. RESULTS The theme "Creating an enabling arena" illuminates how HCPs face possibilities and challenges when enabling children to communicate and participate in clinical encounters. HCPs, parents, and the healthcare system need to adjust to the child. The sub-theme "Bringing different perspectives" describes how children and their parents cooperate and complement each other during healthcare encounters. The sub-theme "Building a safe and comfortable setting" includes how HCPs address the child's self-identified needs and make the child feel comfortable during encounters. The sub-theme "Facilitating methods in a limiting organisation" includes how HCPs' working methods and organization may help or hinder child participation during encounters. CONCLUSIONS HCPs encourage children and adolescents to make their views known during healthcare encounters by creating an enabling arena. Collaboration and building good relationships between the child, the parents and the HCPs, before and during the healthcare encounters, can help the child express their wishes and experiences. Clinical examinations and use of technology, such as photos, films and web-bases questionnaires can be a good start for a better child communication in healthcare encounters.IMPLICATIONS FOR REHABILITATIONHealthcare professionals in JIA teams experience that they can facilitate communication and participation with children and adolescents in healthcare encounters.When healthcare professionals enable both children, adolescents and their parents to bring their perspectives, these views complement one another and enrich information during healthcare encounters.Children and adolescents are more empowered to participate, when healthcare professionals create a good relationship with the child and their parents, and strengthen the child's knowledge, confidence and autonomy.
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Affiliation(s)
- Veronica Lundberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
| | - Marlene Sandlund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Catharina Eriksson
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden.,Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Rebecka Janols
- Department of Computing Science, Umeå University, Umeå, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
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Adolescents’ right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia. Int J Public Health 2020; 65:1235-1246. [DOI: 10.1007/s00038-020-01454-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/27/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022] Open
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Parry RA, Sayner R, Davis SA, Beznos BY, Carpenter DM, Sleath BL. Communication about Contraception with Adolescent Females with Asthma in Pediatric Visits. J Pediatr Adolesc Gynecol 2020; 33:372-376. [PMID: 32087401 PMCID: PMC7434659 DOI: 10.1016/j.jpag.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 11/26/2022]
Abstract
STUDY OBJECTIVE The occurrence and characteristics of contraception discussions with adolescents are unexplored. Our study sought to address this gap using transcripts of audiotaped healthcare visits. DESIGN, SETTING, AND PARTICIPANTS This study was a secondary analysis of 153 transcripts of medical visits with female adolescents with asthma. Medical visits took place among 4 outpatient clinics in North Carolina. MAIN OUTCOME MEASURES Transcripts were reviewed for occurrence and characteristics of contraception discussions. Demographics were collected from adolescent interviews, caregiver questionnaires, and provider questionnaires. RESULTS Contraception was mentioned in 3% (n = 5) of office visits. Conversations about contraception included the topics of contraception efficacy (20%), contraception side effects (60%), contraception adherence (20%), and adolescent sexual health (20%). No conversations included the topics of contraception indication or alternative methods. CONCLUSIONS Conversations about contraception occurred infrequently in healthcare visits. When conversations did occur, the topics that they covered lacked alignment with guideline recommendations.
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Affiliation(s)
- Rachel A Parry
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Robyn Sayner
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Scott A Davis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Bethany Y Beznos
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Betsy L Sleath
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Lott BE, Okusanya BO, Anderson EJ, Kram NA, Rodriguez M, Thomson CA, Rosales C, Ehiri JE. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority populations: A systematic review. Prev Med Rep 2020; 19:101163. [PMID: 32714778 PMCID: PMC7372149 DOI: 10.1016/j.pmedr.2020.101163] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 06/27/2020] [Accepted: 07/04/2020] [Indexed: 12/16/2022] Open
Abstract
Nine studies intervened on vaccination in racial/ethnic and sexual and gender minorities. Education and reminders increased HPV vaccine series initiation and completion. Lack of high-quality, adequately powered studies warrants further investigation.
Minority youth represent a unique population for public health interventions given the social, economic, and cultural barriers they often face in accessing health services. Interventions to increase uptake of Human Papillomavirus (HPV) vaccination in minority youth have the potential to reduce disparities in HPV infection and HPV-related cancers. This systematic review assesses the effectiveness of interventions to increase HPV vaccine uptake, measured as vaccine series initiation and series completion, among adolescents and young adults, aged 9–26 years old, identifying as a racial and ethnic minority or sexual and gender minority (SGM) group in high-income countries. Of the 3013 citations produced by a systematic search of three electronic databases (PubMed, Embase, and Web of Science) in November 2018, nine studies involving 9749 participants were selected for inclusion. All studies were conducted in the United States and were published from 2015 to 2018. Interventions utilized education, vaccine appointment reminders, and negotiated interviewing to increase vaccination. Participants were Black or African American (44.4%), Asian (33.3%), Hispanic or Latinx (22.2%), American Indian or Alaska Native (11.1%), and SGM (22.2%). Studies enrolled parent–child dyads (33.3%), parents alone (11.1%), and youth alone (55.6%). Vaccine series initiation ranged from 11.1% to 84% and series completion ranged from 5.6% to 74.2% post-intervention. Educational and appointment reminder interventions may improve HPV vaccine series initiation and completion in minority youth in the U.S. Given the lack of high quality, adequately powered studies, further research is warranted to identify effective strategies for improving HPV vaccine uptake for minority populations.
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Affiliation(s)
- Breanne E Lott
- Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Babasola O Okusanya
- Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Elizabeth J Anderson
- Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nidal A Kram
- Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Melina Rodriguez
- Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Cynthia A Thomson
- Canyon Ranch Center for Prevention and Health Promotion, Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Cecilia Rosales
- Division of Public Health Practice and Translational Research, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zukerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Physicians' Attitudes Toward Adolescent Confidentiality Services: Scale Development and Validation. Zdr Varst 2020; 59:99-107. [PMID: 32952709 PMCID: PMC7478075 DOI: 10.2478/sjph-2020-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical acceptability of confidential services in adolescents’ healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents’ access and utilization of healthcare services. Despite legal policies that promote adolescents’ rights, physicians’ attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents’ confidentiality. Method A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations. Results Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents. Conclusions The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians’ awareness of the importance of adolescent confidentiality.
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Abstract
Adolescence is the transitional bridge between childhood and adulthood; it encompasses developmental milestones that are unique to this age group. Healthy cognitive, physical, sexual, and psychosocial development is both a right and a responsibility that must be guaranteed for all adolescents to successfully enter adulthood. There is consensus among national and international organizations that the unique needs of adolescents must be addressed and promoted to ensure the health of all adolescents. This policy statement outlines the special health challenges that adolescents face on their journey and transition to adulthood and provides recommendations for those who care for adolescents, their families, and the communities in which they live.
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Affiliation(s)
- 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; and
| | - Cora C Breuner
- Division of Adolescent Medicine, Departments of Pediatrics and Orthopedics and Sports Medicine, University of Washington and Seattle Children's Hospital, Seattle, Washington
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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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Shafii T, Benson SK, Morrison DM. Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study. J Med Internet Res 2019; 21:e13220. [PMID: 31293242 PMCID: PMC6652122 DOI: 10.2196/13220] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/05/2019] [Accepted: 04/23/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. OBJECTIVE The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. METHODS At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. RESULTS The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. CONCLUSIONS In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents.
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Affiliation(s)
- Taraneh Shafii
- Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Samantha K Benson
- Harborview Medical Center, University of Washington School of Medicine, Seattle, WA, United States
| | - Diane M Morrison
- School of Social Work, University of Washington, Seattle, WA, United States
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Jeremic Stojkovic V, Matejic B, Turza K. Serbian primary care physicians' perspectives on adolescents' right to confidentiality in sexual and reproductive healthcare-a qualitative interview study. Fam Pract 2019; 36:317-324. [PMID: 29982433 DOI: 10.1093/fampra/cmy067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In prominent international documents and professional position papers, confidentiality was recognized as a necessary condition for effective reproductive healthcare of adolescents. Although legally guaranteed, it is questionable if the right to confidentiality of adolescents is respected in healthcare practice in Serbia. OBJECTIVES To assess primary care physicians' perspectives on the legal right of minors to confidentiality in sexual and reproductive healthcare, as well as their experiences in practice. METHODS Qualitative, semi-structured face-to-face interviews with 12 primary care pediatricians and gynecologists at several municipalities of the city of Belgrade were performed. Interview transcripts were analyzed using qualitative content analysis method. RESULTS Most interviewees were aware of their legal obligations and support the general idea of granting adolescents the right to confidentiality. They recognized that the lack of confidentiality assurances prevents adolescents' access to sensitive care. However, physicians expressed concerns regarding medical situations when parents should be notified, which was reflected in their inconsistent respect of said right in actual practice. Several organizational obstacles were emphasized by interviewees, including insufficient number of physicians, time constraints, poor access to gynecological services and vague definitions of legal provisions. CONCLUSION If the aim is for adolescents' right to confidentiality to be consistently respected in practice, primary care physicians need to be systematically educated about legal provisions and given comprehensive clinical guidelines. The general positive attitude towards confidentiality expressed by the primary care physicians implies that a possibility exists to engage them as main advocates for improvements in access to the necessary health care.
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Affiliation(s)
| | - Bojana Matejic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Serbia
| | - Karel Turza
- Department of Humanities, Faculty of Medicine, University of Belgrade, Serbia
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O'Sullivan LF, Majerovich JA, Wuest J. From Promoting Healthy Sexual Functioning to Managing Biomedical Sexual Dysfunction: Health Professional Views of Youth Sexual Health. SAGE Open Nurs 2019; 5:2377960819832676. [PMID: 33415225 PMCID: PMC7774441 DOI: 10.1177/2377960819832676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 01/15/2019] [Accepted: 01/25/2019] [Indexed: 01/23/2023] Open
Abstract
A body of work emerging in the last few years has expanded the focus of youth
sexual health to include problems in sexual functioning. Recent surveys show
that rates of youth sexual functioning problems are similar to those of adults.
Physicians' lack of awareness about problems of sexual functioning has been
identified as a major obstacle in treatment. Yet little is known about
health-care provider (HCP) perspectives on youth sexual functioning. We
conducted a descriptive qualitative study with HCPs to learn about their
perceptions of adolescent sexual problems and HCP roles in managing these issues
including sexual functioning. Nineteen HCPs: Family physicians, nurse
practitioners, and public health nurses working primarily with youth in
universities, schools, or sexual health clinics were recruited to draw on their
expert knowledge and experience. All completed in-depth individual interviews.
Data were analyzed using directed qualitative content analysis. Our findings
illuminate inconsistent views. Some HCPs, particularly those in youth-focused
services, adopt a holistic role in promoting healthy sexual functioning, and
others, commonly those in general practice, attend only to biomedical issues
related to sexual dysfunction. All HCPs in our study were challenged by a
paucity of sexual health preparation in their formal education. HCP interest in
youth sexual health affected their efforts to acquire new information and
training and, along with the structure of their practice setting, influenced
whether they framed their role in youth sexual health holistically within a
context of social determination or constrained their role to a medical model.
These findings draw attention to the need for new approaches for strengthening
knowledge, training, and resources to foster HCP promotion of healthy sexual
functioning and prevention of lifelong sexual health problems.
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Affiliation(s)
- Lucia F O'Sullivan
- Department of Psychology, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Judith Wuest
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
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Miklin DJ, Vangara SS, Delamater AM, Goodman KW. Understanding of and Barriers to Electronic Health Record Patient Portal Access in a Culturally Diverse Pediatric Population. JMIR Med Inform 2019; 7:e11570. [PMID: 31066681 PMCID: PMC6526688 DOI: 10.2196/11570] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 02/04/2019] [Accepted: 03/24/2019] [Indexed: 11/21/2022] Open
Abstract
Background Electronic health records (EHRs) have become a standard in the health care setting. In an effort to improve health literacy, foster doctor-patient communication, and ease the transition from adolescent to adult care, our institution created a policy that allows patients aged between 13 and 17 years to have EHR portal access. A literature review revealed predictable differences in portal registration among different ethnicities and socioeconomic statuses. Consequently, a cross-sectional survey was developed to investigate barriers to EHR portal access in a sample of culturally diverse adolescents. Objective The aim of this study was to assess for barriers to EHR portal access in a culturally diverse adolescent population. Methods A 42-item anonymous survey was completed by 97 adolescents aged between 13 and 18 years, attending general pediatrics clinics. The results were analyzed using descriptive statistics and t tests. Results The average participant age was 15.5 (SD 1.5) years with 60% (58/97) male and 40% (39/97) female. Participants were 44% (43/97) black, 41% (40/97) Hispanic, 9% (9/97) Caucasian, 3% (3/97) Asian, and 2% (2/97) others. There were statistically significant differences in perceptions of confidentiality in age (13 to 15 years vs 16 to 18 years; P=.001) and insurance status (government vs private; P=.012) but not in gender, ethnicity, or parental education level. Younger adolescents with governmental insurance were more confident in the level of confidentiality with their physician. A total of 94% of participants had heard of the term EHR, but only 55% were familiar with its function. Furthermore, 77% of patients primarily accessed the internet through phones, and 50% of participants knew that patients aged under 18 years could obtain care for mental health, substance abuse, sexual health, and pregnancy. Conclusions This research has identified gaps in EHR technology with regard to the pediatric patient population. The results of our survey show that adolescents may have misconceptions regarding the doctor-patient relationship, their ability to obtain care, and the modalities present in an EHR. As technology progresses, it is essential to have a deeper understanding of adolescents’ perceptions of confidentiality, technology, and available resources to design an EHR system that encourages patient education and communication while limiting barriers to care.
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Affiliation(s)
- Daniel J Miklin
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Sameera S Vangara
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, FL, United States
| | - Kenneth W Goodman
- University of Miami Miller School of Medicine, Institute for Bioethics and Health Policy, Miami, FL, United States
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O'Sullivan LF, Wuest J, Byers ES. Figuring It Out: How Late Adolescent and Young Adult Men and Women Perceive and Address Problems in Sexual Functioning. JOURNAL OF SEX RESEARCH 2019; 56:327-336. [PMID: 29333876 DOI: 10.1080/00224499.2017.1416451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Although there are high rates of sexual problems and sexual dysfunction in adulthood (Mitchell et al., 2013), little is known about the circumstances under which problems are first experienced. A growing body of research addresses prevalence of problems in sexual functioning among adolescents and young adults, yet little is known about the meanings that young people give to these experiences or how they deal with them. We used content analysis of qualitative interviews with 53 heterosexual, sexually active Canadian adolescents (ages 18 to 21) to explore their perceptions of the sexual problems in functioning they had experienced and the strategies (if any) they used to address them over time. Problems among most young people originated early in their partnered sexual life. Figuring it out emerged as an intentional process directed toward improving sexual experiences, although certainly not all young people were successful. Strategies for figuring it out included informational or material help seeking, experimentation to inform future actions, mutual sharing and problem solving, and building emotional connection to improve sexual functioning. Implications for understanding the development of sexual dysfunctions in adulthood are discussed.
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Affiliation(s)
| | - Judith Wuest
- b Faculty of Nursing, University of New Brunswick
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Confidentiality Discussions and Private Time With a Health-Care Provider for Youth, United States, 2016. J Adolesc Health 2019; 64:311-318. [PMID: 30638752 DOI: 10.1016/j.jadohealth.2018.10.301] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of the study was to define factors associated with adolescent and young adult (AYA) experiences with private time and having discussed confidentiality and the impact of these experiences on improving delivery of clinical preventive services. METHODS In 2016, a nationally representative sample of 1,918 US AYAs (13- to 26-year-olds) was surveyed. Survey questionnaire domains were based on prior research and Fishers' information-motivation-behavior skills conceptual model. Data were weighted to represent US households with AYA and analyzed to identify factors independently associated with ever experiencing private time and discussions of confidentiality with a regular health-care provider (HCP). We examined the association of these experiences on AYA attitudes about health care. RESULTS Fifty-five percent of female and 49% of male AYA reported ever having had private time with an HCP and 55% of female and 44% of male AYA had spoken to an HCP about confidentiality. Independent predictors of having experienced private time and confidentiality included older age, race, higher household income, gender of the provider, amount of years with the provider, and involvement in risk behaviors. AYA who had experienced private time and confidentiality discussions had more positive attitudes about their providers, were more willing and comfortable discussing sensitive topics, and thought that these discussions should happen at younger ages. CONCLUSIONS Although confidentiality and private time are important to AYA, many are not experiencing these components of care. Providing private time and discussions of confidentiality can improve the delivery of health care for young people by enhancing positive youth attitudes about preventive care.
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Song X, Klein JD, Yan H, Catallozzi M, Wang X, Heitel J, Kaseeska K, Gorzkowski J, Santelli JS. Parent and Adolescent Attitudes Towards Preventive Care and Confidentiality. J Adolesc Health 2019; 64:235-241. [PMID: 30396723 DOI: 10.1016/j.jadohealth.2018.08.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Little is known about whether parents and adolescents agree in their attitudes towards preventive care, private time, and confidentiality for adolescent care. METHODS We surveyed a nationally representative sample of 1,209 13-18 year-old U.S. adolescents and their parents. Parent and adolescents attitudes towards preventive services, private time, and confidentiality were compared. Parent-youth dyad agreement was measured using Cohen's kappa and Spearman coefficients and modeled for association with demographic variables. RESULTS Parents are more likely than adolescents to think preventive services are important (71% vs. 48%; p < .001). Parent-youth attitudes were weakly to moderately correlated (Cohen's kappa coefficient = .22; p < .001). Parents and adolescents report similar ages for when teens should start having private time (median 16 years for both) and many think this age should be at 18, the legal age of adulthood). Fewer than half believe confidentiality should be provided for 10 services, ranging from routine care to abortion care (parents range: 12.8%-52.3%; adolescents: 24.0%-58.8%). While most adolescents agreed with their parents, teens were more likely to report wanting confidential access than parents. Older age, Hispanic ethnicity, having divorced parents and higher family income were associated with both adolescent/parent and adolescent endorsement of confidentiality. CONCLUSIONS Adolescents and parents generally agree about the importance of preventive services, private time, confidentiality, and what should and should not be confidential. On average, parents value clinical preventive services more than youth, and youth value confidentiality more than parents. Both believe private time should start at ages older than those recommended in clinical guidelines.
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Affiliation(s)
- Xiaoyu Song
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago College of Medicine, Chicago, Illinois; Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, Illnois.
| | - Hanying Yan
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Marina Catallozzi
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Xianling Wang
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Jenifer Heitel
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Kristen Kaseeska
- Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, Illnois
| | - Julie Gorzkowski
- Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, Illnois
| | - John S Santelli
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center, New York, New York
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Pathak PR, Chou A. Confidential Care for Adolescents in the U.S. Health Care System. J Patient Cent Res Rev 2019; 6:46-50. [PMID: 31414023 DOI: 10.17294/2330-0698.1656] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In providing care for adolescents, maintaining confidentiality should be considered a human right and an evidence-based component of quality care. Unfortunately, complexities in the U.S. legal and health care systems have created a setting in which confidential care is inaccessible to many adolescent patients. Federal laws provide a minimum standard for confidentiality protections, but variations in state legislation relating to minor consent, special health care services, and confidentiality exemptions create large variability in adolescent confidentiality rights across the country. In certain contexts, such as consensual sexual activity, legal provisions may not align with professional ethical standards in adolescent care. In addition, contemporary clinical and administrative issues related to the electronic health record and health care financing also threaten to breach confidentiality. Although further research is necessary, providers and institutions are already well positioned to broaden protections by implementing best practices in training and education, workflow, and medical records related to adolescent confidentiality.
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Affiliation(s)
- Priya R Pathak
- Harvard T.H. Chan School of Public Health, Boston, MA.,University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Adriana Chou
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Masonbrink AR, Stancil S, Reid KJ, Goggin K, Hunt JA, Mermelstein SJ, Shafii T, Lehmann AG, Harhara H, Miller MK. Adolescent Reproductive Health Care: Views and Practices of Pediatric Hospitalists. Hosp Pediatr 2019; 9:100-106. [PMID: 30622112 DOI: 10.1542/hpeds.2018-0051] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Many hospitalized adolescents are at increased risk for pregnancy complications due to an underlying medical condition, however sexual risk assessment is not consistently performed in this setting. While adolescents and their parents are supportive of sexual health discussion in the inpatient setting, a thorough understanding of factors that influence provision of this care among pediatric hospital physicians is lacking. This formative information is needed to facilitate efforts to improve and standardize clinical care provision. Our objective is to assess the frequency and factors that influence the provision of adolescent sexual and reproductive care by pediatric hospitalists. METHODS We performed a cross-sectional computerized survey of hospitalists at 5 pediatric hospitals who cared for ≥1 adolescent (14-21 years old) in the past year. Sexual and reproductive care practices were assessed by using a 76-item novel survey informed by the theory of planned behavior. We used descriptive statistics to summarize the data. RESULTS Sixty-eight pediatric hospitalists participated (49% response rate): 78% were women and 65% were aged <40 years. Most (69%) reported treating >46 adolescents annually, including many who are at an increased risk for pregnancy complications due to teratogenic medication use or a comorbid condition. A majority felt that sexual and reproductive services are appropriate, although many endorsed barriers, including concern about follow-up after emergency contraception (63%) and time constraints (53%). Most reported insufficient knowledge regarding contraception (59%), desired contraception education (57%), and were likely to increase contraceptive provision if provided education (63%). Hospitalists rarely provided condoms or referral for an intrauterine device. CONCLUSIONS Pediatric hospitalists frequently care for adolescents who are at risk for pregnancy complications and generally agree that reproductive care is appropriate in the inpatient setting. With these findings, we highlight the critical need for effective comprehensive reproductive health service interventions that are tailored to address the numerous actionable barriers identified in this study.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; .,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Stephani Stancil
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Kathy Goggin
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,Division of Health Services and Outcomes Research and
| | - Jane Alyce Hunt
- Department of Pediatrics, St Louis Children's Hospital and School of Medicine, Washington University, St Louis, Missouri
| | - Sarah J Mermelstein
- Department of Pediatrics, St Louis Children's Hospital and School of Medicine, Washington University, St Louis, Missouri
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Amber G Lehmann
- Department of Pediatrics, East Carolina University, Greenville, North Carolina; and
| | - Haleema Harhara
- Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, Texas
| | - Melissa K Miller
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Trotman GE, Mackey E, Tefera E, Gomez-Lobo V. Comparison of Parental and Adolescent Views on the Confidential Interview and Adolescent Health Risk Behaviors within the Gynecologic Setting. J Pediatr Adolesc Gynecol 2018; 31:516-521. [PMID: 29580917 DOI: 10.1016/j.jpag.2018.03.006] [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: 12/15/2017] [Revised: 02/19/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE To explore parental and adolescent views on the confidential interview in the gynecologic setting and compare adolescent reported risk-taking behaviors with parental perception. DESIGN Anonymous surveys were administered separately to parents/guardians and adolescents between the ages of 11 and 17 years. Information pertaining to the patient's Tanner stage and reason for visit was obtained from the provider. This first phase served as the usual care group. In the second phase of the study, surveys were again distributed after a brief educational intervention. Linear regression analysis, Wilcoxon rank sum test, and Fisher exact test were used where appropriate. SETTING AND PARTICIPANTS Pediatric and adolescent gynecology clinics in 2 tertiary hospitals. INTERVENTIONS Brief educational handout on key concepts of the confidential interview. MAIN OUTCOME MEASURES Parental perception of the confidential interview and adolescent risk-taking behaviors. RESULTS A total of 248 surveys were included in the final analysis, which accounts for 62 adolescent and parent/guardian pairs in each group. Most parents and adolescents reported perceived benefit to the confidential interview. However, parents were less likely to rate benefits of private time specifically for their own adolescent and less than half of the parents believed that adolescents should have access to private time in the gynecologic setting. Parents/guardians as well as adolescents feared that the confidential interview would limit the parent's ability to take part in decision-making. The low support for confidential time for their adolescent was not different in the usual care group compared with the intervention group, although there was a trend toward parental acceptance with increased adolescent age. Adolescents were consistently more likely to report more risk-taking behaviors than their parents perceived. CONCLUSION There is a discord between parental perception and adolescent reports of risk-taking behaviors. This is coupled with a lack of understanding or comfort regarding the benefits of the confidential interview among parents and adolescents who present for gynecologic care. A short educational intervention had only a modest effect on parental perceptions regarding the confidential interview.
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Affiliation(s)
- Gylynthia E Trotman
- Children's National Health Services, Pediatric and Adolescent Gynecology, Washington, DC; Medstar Washington Hospital Center, Department of Obstetrics and Gynecology, Washington, DC.
| | - Eleanor Mackey
- Children's National Health Services, Department of Psychology and Behavioral Health, Washington, DC
| | | | - Veronica Gomez-Lobo
- Children's National Health Services, Pediatric and Adolescent Gynecology, Washington, DC; Medstar Washington Hospital Center, Department of Obstetrics and Gynecology, Washington, DC; MedStar Georgetown University School of Medicine, Department of Obstetrics and Gynecology, Washington, DC
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Masonbrink AR, Richardson T, McCulloh RJ, Hall M, Bettenhausen JL, Walker JM, Johnson MB, Queen MA, Markham JL, Goyal MK. Sexually Transmitted Infection Testing in Adolescents: Current Practices in the Hospital Setting. J Adolesc Health 2018; 63:342-347. [PMID: 30072303 PMCID: PMC6269275 DOI: 10.1016/j.jadohealth.2018.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Adolescents are disproportionately affected by sexually transmitted infections (STIs), and evidence supports expanding sexual health services to the hospital setting. Because STI testing practices in the hospital setting are poorly understood, we sought to describe current STI testing practices among adolescents seen in children's hospitals. METHODS We performed a retrospective analysis of adolescents (14-18 years old) from 45 children's hospitals in 2015-2016, excluding visits with a billing code for sexual abuse/assault. We calculated rates of STI testing and investigated differences in STI testing by patient and hospital characteristics using generalized linear mixed modeling. RESULTS Of the 541,714 adolescent encounters, 59,158 (10.9%) underwent STI testing. After adjusting for demographic characteristics, those with an STI test were more likely to be female (adjusted odds ratio [aOR] 1.61; 95% confidence interval [CI] 1.58-1.64), of non-Hispanic black race/ethnicity (aOR 1.20; 95% CI 1.17-1.23), or from the lowest median household income quartile (aOR 1.21; 95% CI 1.17-1.24). There was substantial inter-hospital variation in adjusted rates of STI testing (3%-24%), but strong correlation was observed between STI testing rates in the ED and inpatient settings within individual hospitals (adjusted R2 .99). CONCLUSIONS Only one in ten adolescents seen in children's hospitals underwent STI testing with wide variation in testing patterns across hospitals. There are critical opportunities to increase adolescent STI testing in this setting. Our findings highlight potential disparities in STI testing rates and patterns that warrant further exploration from the patient, provider, and health system perspective.
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Affiliation(s)
- Abbey R. Masonbrink
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA
| | - Troy Richardson
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA,Children’s Hospital Association, 16011 College Blvd., Suite 250, Lenexa, KS 66219, USA
| | - Russell J McCulloh
- Department of Pediatrics, Children’s Hospital & Medical Center, 8200 Dodge Street, Omaha, Nebraska 68114, USA,Division of Emergency Medicine, Children’s National Medical Center, 2141 K St NW, Washington DC 20037, USA,Affiliation at the time work was completed: Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO, USA
| | - Matt Hall
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA,Children’s Hospital Association, 16011 College Blvd., Suite 250, Lenexa, KS 66219, USA
| | - Jessica L. Bettenhausen
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA
| | - Jacqueline M. Walker
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA
| | - Matthew B. Johnson
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA
| | - Mary Ann Queen
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA
| | - Jessica L. Markham
- Department of Pediatrics, Children’s Mercy Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, MO 2401 Gilham Rd, Kansas City MO 64108, USA
| | - Monika K. Goyal
- Division of Emergency Medicine, Children’s National Medical Center, 2141 K St NW, Washington DC 20037, USA
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Miller VA, Friedrich E, García-España JF, Mirman JH, Ford CA. Adolescents Spending Time Alone With Pediatricians During Routine Visits: Perspectives of Parents in a Primary Care Clinic. J Adolesc Health 2018; 63:280-285. [PMID: 29887486 DOI: 10.1016/j.jadohealth.2018.01.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/05/2018] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To increase understanding of parental perspectives on time alone and of factors that influence adolescent communication with physicians in a pediatric clinic. METHODS The sample consisted of 91 parents of adolescents aged 14-17 years who attended a well child visit at one primary care pediatric practice and completed a 2-week follow-up phone call as part of a larger study on adolescent health and communication. Parents reported whether their child met alone with the pediatrician, rated the importance of him or her having time alone with the physician, and responded to open-ended questions regarding barriers and facilitators of adolescent-physician communication. Bivariate and multivariate analyses tested associations of parent and adolescent characteristics with perceived parental importance of time alone. We conducted content analyses of responses to open-ended questions. RESULTS Slightly more than half of parents (n = 53, 58%) indicated that it was "a lot" important for their adolescents to meet alone with the pediatrician; parents of males were more likely than parents of females to select this highest rating (73% vs. 43%, χ2(1) = 8.34, p = .004; adjusted odds ratio 4.88, 95% confidence interval 1.84-12.96). Responses to open-ended questions identified numerous adolescent, parent, and provider factors that parents perceived to influence adolescent-physician communication during well child visits, such as preparation for visit, rapport and familiarity with the pediatrician, privacy concerns, time alone with the pediatrician, emotional comfort, trust, and support. CONCLUSIONS Most parents thought time alone was highly important for their own adolescent in a primary care setting, and parents described additional strategies to facilitate adolescent communication.
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Affiliation(s)
- Victoria A Miller
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elizabeth Friedrich
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - J Felipe García-España
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jessica H Mirman
- Department of Psychology, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Carol A Ford
- Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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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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McKee MD, Alderman E, York DV, Blank AE, Briggs RD, Hoidal KES, Kus C, Lechuga C, Mann M, Meissner P, Patel N, Racine AD. A Learning Collaborative Approach to Improve Primary Care STI Screening. Clin Pediatr (Phila) 2018; 57:895-903. [PMID: 29027480 DOI: 10.1177/0009922817733702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Bronx Ongoing Pediatric Screening (BOPS) project sought to improve screening for sexual activity and sexually transmitted infections (gonorrhea and chlamydia [GCC] and HIV) in a primary care network, employing a modified learning collaborative, real-time clinical data feedback to practices, improvement coaching, and a pay-for-quality monetary incentive. Outcomes are compared for 11 BOPS-participating sites and 10 non-participating sites. The quarterly median rate for documenting sexual activity status increased from 55% to 88% (BOPS sites) and from 13% to 74% (non-BOPS sites). GCC screening of sexually active youth increased at BOPS and non-BOPS sites. Screening at non-health care maintenance visits improved more at BOPS than non-BOPS sites. Data from nonparticipating sites suggests that introduction of an adolescent EMR template or other factors improved screening rates regardless of BOPS participation; BOPS activities appear to promote additional improvement of screening during non-health maintenance visits.
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Affiliation(s)
- M Diane McKee
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore Health System, Bronx, NY, USA
| | | | | | | | - Rahil D Briggs
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore Health System, Bronx, NY, USA
| | - Kelsey E S Hoidal
- 5 Banner-University Medical Center, University of Arizona, Tucson, AZ, USA
| | - Christopher Kus
- 6 New York State Department of Health, Division of Family Health, Albany, NY, USA
| | | | - Marie Mann
- 7 Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, MD, USA
| | - Paul Meissner
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore Health System, Bronx, NY, USA
| | - Nisha Patel
- 1 Albert Einstein College of Medicine, Bronx, NY, USA
| | - Andrew D Racine
- 1 Albert Einstein College of Medicine, Bronx, NY, USA.,2 Montefiore Health System, Bronx, NY, USA
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Baldridge S, Symes L. Just between Us: An Integrative Review of Confidential Care for Adolescents. J Pediatr Health Care 2018; 32:e45-e58. [PMID: 29249646 DOI: 10.1016/j.pedhc.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/13/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Confidential care is recommended for all adolescents to facilitate risk behavior screening and discussion of sensitive topics. Only 40% of adolescents receive confidential care. The purpose of this integrative review is to describe research related to the practice of confidential care for adolescents. Evidence was analyzed to identify strategies to increase confidential care and improve risk behavior screening. METHOD Whittemore and Knafl's integrative literature review process was applied. RESULTS The 26 research articles included in this review included patients', parents', and physicians' perspectives. Confidential care practice is inconsistent. Strategies to improve practice are known. CONCLUSIONS Four key elements should be considered to establish a practice culture of confidential care for adolescents. Strategies for implementing the key elements of confidential care and supporting resources for efficient use of time alone are provided.
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Goldstein RL, Carlson JL, Halpern-Felsher B. Contraception for Adolescents and Young Adults in the Inpatient Setting: The Providers' Perspective. Hosp Pediatr 2018; 8:194-199. [PMID: 29496729 DOI: 10.1542/hpeds.2017-0167] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess pediatric providers' attitudes and barriers to initiating a contraceptive method in the inpatient setting. METHODS Pediatric attending physicians and trainees from 5 academic institutions were surveyed about contraceptive prescribing practices, attitudes, and potential barriers to initiating contraception in the inpatient setting. RESULTS In 2016, 271 pediatric providers (34.0% were attending physicians, 18.1% fellows, and 47.9% residents) completed the survey; the response rate was 19.2%. Most participants practiced in both inpatient and outpatient settings (95.7% and 85.0%, respectively). More providers felt confident screening for sexual activity among young adults as compared with adolescents (71.9% vs 65.6%). The same was true for discussing contraceptive options (44.0% vs 38.8%, respectively). Inpatient providers reported seeing adolescents and young adults privately, discussing confidentiality, and asking about sex less than half of the time. More than 80% of providers agreed that it would be appropriate to initiate a contraceptive method for inpatients; 35.8% had done so, and 85.2% indicated that having additional consultation would increase initiation of a contraceptive method in the hospital (88.1% felt similarly for long-active reversible contraception methods). General barriers to initiating contraception included insufficient training, insufficient exposure to adolescents and young adults to maintain skills, and lack of time. Barriers specific to the inpatient setting included concerns about follow-up, confidentiality, and interference with the treatment plan. CONCLUSIONS Initiation of a contraceptive method in the inpatient setting is acceptable to providers. In our findings, it is suggested that strategies are needed to enhance provision of these services by addressing confidentiality concerns and educating providers.
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Affiliation(s)
- Rachel L Goldstein
- Division of Adolescent Medicine, Stanford University, Palo Alto, California
| | - Jennifer L Carlson
- Division of Adolescent Medicine, Stanford University, Palo Alto, California
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Abstract
Objectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents' recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement an intervention in a practice-based research network delivering private, comprehensive HRAs via tablet (Phase II). Providers and adolescents received geo-coded community resources according to individualized risks. Following the point-of-care implementation , we collected patient-reported outcomes using post-visit quality surveys (Phase III). Patient-reported outcomes from intervention and comparison clinics were analyzed using a mixed-model, fitted separately for each survey domain. Results Stakeholders agreed upon an HIT-enhanced HRA (Phase I). Twenty-two academic and community practices in north-central Florida then recruited 609 diverse adolescents (14-18 years) during primary care visits over 6 months; (mean patients enrolled = 28; median = 20; range 1-116; Phase II). Adolescents receiving the intervention later reported higher receipt of confidential/private care and counseling related to emotions and relationships (adjusted scores 0.42 vs 0.08 out of 1.0, p < .01; 0.85 vs 0.57, p < .001, respectively, Phase III) than those receiving usual care. Both are important quality indicators for adolescent well-child visits. Conclusions Stakeholder input was critical to the acceptability of the HIT-enhanced HRA. Patient recruitment data indicate that the intervention was feasible in a variety of clinical settings and the pilot evaluation data indicate that the intervention may improve adolescents' perceptions of high quality care.
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Todres J, Diaz A. Adolescents' Right to Participate: Opportunities and Challenges for Health Care Professionals. Ann Glob Health 2017; 83:697-703. [PMID: 29248084 DOI: 10.1016/j.aogh.2017.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Health care professionals and patients are partners in health care delivery, and this partnership is critical in the treatment of adolescents. International children's rights law establishes that all children have a right to participate in decisions that affect their lives. Fulfillment of that right is as critical in health care settings as any other area of children's lives. OBJECTIVES In this article we examine the right to participate under international children's rights law, its relevance to health care settings, and how health care professionals can foster adolescents' participation to fulfill children's rights and improve health care outcomes. FINDINGS The Convention on the Rights of the Child establishes a legal mandate-where ratified-that adolescents have the right to express their views in health care settings and that such views must be given due consideration. In many health care settings, adolescents are not adequately consulted or have limited opportunities to express their views. A review of research finds that both processes and outcomes can improve when youth participation is cultivated. CONCLUSIONS Health care providers and organizations have numerous opportunities to cultivate adolescent's participation rights and in doing so improve health care delivery and outcomes. Health care providers and organizations should further develop structures and processes to ensure opportunities for children and adolescents to be heard on matters relevant to their health care and health status. Creating opportunities for adolescents to realize their right to participate means engaging youth at every stage in the process, beginning with the design of such opportunities. It also means addressing all aspects of health care, from the built environment to patient-provider communication to follow-up services, so that the entire process fosters an environment conductive to meaningful participation by adolescents.
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Affiliation(s)
- Jonathan Todres
- Center for Law, Health & Society, Georgia State University College of Law, Atlanta, GA.
| | - Angela Diaz
- Department of Pediatrics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
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Davidson LF, Doyle M, Silver EJ. Discussing Future Goals and Legal Aspects of Health Care: Essential Steps in Transitioning Youth to Adult-Oriented Care. Clin Pediatr (Phila) 2017; 56:902-908. [PMID: 28466656 DOI: 10.1177/0009922817706142] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Discussing realistic future goals with the adolescent alone and with family, and reviewing legal aspects of health care transition (HCT), are essential steps in the transition from pediatric to adult-oriented care. Secondary analysis of datasets from 2 studies related to HCT assessed differences in provider practice for youth with and without special health care needs (SHCNs). Across both datasets, between 57% and 68.6% of providers reported some discussion of future goals with adolescent or with family. However, only 28.6% to 31% of providers reported discussing future goals with youth with SHCNs alone. It was rare for providers to report discussing legal aspects of HCT with any youth. Findings identify a gap in discussing future goals and legal aspects of HCT, as part of routine care for adolescents. Additional research to understand barriers and improve likelihood of these steps within HCT is needed.
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Affiliation(s)
- Lynn F Davidson
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Maya Doyle
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.,2 Quinnipiac University, Hamden, CT, USA
| | - Ellen J Silver
- 1 Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
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