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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Technical Report. Pediatrics 2024; 153:e2024066327. [PMID: 38646698 DOI: 10.1542/peds.2024-066327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is a foundational element of high-quality, accessible, and equitable health care. Despite strong grounding in federal and state laws, professional guidelines, and ethical standards, health care professionals and adolescent patients face a range of complexities and barriers to seeking and providing confidential care to adolescents across different settings and circumstances. The dynamic needs of adolescents, the oftentimes competing interests of key stakeholders, the rapidly evolving technological context of care, and variable health care billing and claims requirements are all important considerations in understanding how to optimize care to focus on and meet the needs of the adolescent patient. The following assessment of the evolving evidence base offers a view of the current state and best practices while pointing to numerous unmet needs and opportunities for improvement in the care experiences of youth as well as their health outcomes.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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Chung RJ, Lee JB, Hackell JM, Alderman EM. Confidentiality in the Care of Adolescents: Policy Statement. Pediatrics 2024; 153:e2024066326. [PMID: 38646690 DOI: 10.1542/peds.2024-066326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2024] [Indexed: 04/23/2024] Open
Abstract
Confidentiality is an essential component of high-quality health care for adolescents and young adults and can have an impact on the health care experiences and health outcomes of youth. Federal and state laws, professional guidelines, and ethical standards provide a core framework for guidance in the implementation of confidentiality protections in clinical practice. This policy statement provides recommendations for pediatricians and other pediatric health care professionals, clinics, health systems, payers, and electronic health record developers to optimize confidentiality practices and protections for adolescents and young adults across the spectrum of care.
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Affiliation(s)
- Richard J Chung
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
| | - Janet B Lee
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Jesse M Hackell
- Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Elizabeth M Alderman
- Division of Adolescent Medicine, Department of Pediatrics, Albert Einstein College of Medicine and The Children's Hospital at Montefiore, Bronx, New York
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McNeill-Johnson A, Miller M, Stancil S, Randell KA. Sexual and Reproductive Health Care Utilization for Youth Experiencing Homelessness. Clin Pediatr (Phila) 2024:99228241249403. [PMID: 38682641 DOI: 10.1177/00099228241249403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- April McNeill-Johnson
- Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- School of Medicine, The University of Kansas, Kansas City, KS, USA
| | - Melissa Miller
- Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Stephani Stancil
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- Divisions of Adolescent Medicine, Clinical Pharmacology, and Toxicology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, USA
- School of Medicine, The University of Kansas, Kansas City, KS, USA
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Sethness JL, Golub S, Evans YN. Adolescent patient portals and concerns about confidentiality. Curr Opin Pediatr 2023; 35:430-435. [PMID: 37036289 DOI: 10.1097/mop.0000000000001252] [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: 04/11/2023]
Abstract
PURPOSE OF REVIEW To better understand confidentiality issues that arise from adolescent access to patient portals. RECENT FINDINGS Studies have evaluated the views of teens, parents, providers, and institutional leadership on adolescent patient portals and the risks they pose to adolescent privacy. Additional investigations have shown that teen portal accounts are often inappropriately accessed by parents. Guidelines are needed to better inform the creation of secure teen patient portals. Adolescent providers and other medical staff should be aware of the information available on portals, how to ensure portals are being accessed appropriately, and the potential for confidentiality breaches that come with portal use. Medical organizations that offer portal access need to provide resources to adolescents and their families to improve understanding around the importance of confidential care and how to maintain confidentiality while still engaging meaningfully with the healthcare system through patient portals. SUMMARY Adolescents realize the benefits portals may offer regarding improved understanding of their health conditions, communication with their providers, and autonomy in their healthcare decisions. However, confidentiality of patient portals is a major concern and a potential barrier to adolescent portal utilization. Adolescent providers should be aware of the limitations of portal systems and advocate for improved confidentiality functionality to ensure teens can access the benefits of patient portals without any harm.
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Affiliation(s)
- Janis L Sethness
- Division of Adolescent Medicine, Seattle Children's Hospital
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Sarah Golub
- Division of Adolescent Medicine, Seattle Children's Hospital
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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Fernandez T, Kaul P. Turning HEADSS: Utilizing Coached Role-Play to Increase Student Self-Efficacy with Adolescent Interviewing Skills. J Physician Assist Educ 2023; 34:152-156. [PMID: 37133891 DOI: 10.1097/jpa.0000000000000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Adolescent patients make up a significant number of the primary care population, yet medical training specific to adolescents is inadequate and challenging. 2 Medical trainees report feeling less competent caring for adolescents compared to caring for infants and children. 3 Framed after an adolescent HEADSS (Home, Education/employment, peer group Activities, Drugs, Sexuality and Suicide/depression) interview role-play activity for pediatric clerkship students, 1,2 this study sought to investigate the impact that facilitated role-play would have on physician assistant (PA) students' self-perceived knowledge, skills, and comfort in interviewing adolescents. METHODS A coached role-play focused on skills used during a HEADSS interview was used to demonstrate the communication skills inherently important to adolescent encounters. Pre- and postintervention surveys were administered. RESULTS Data from 2 sequential cohorts (n = 88) showed statistically significant improvement in pre- versus postsession self-perception of knowledge ( p ≤ 0.0001) and skills ( p ≤ 0.0001), but not in comfort ( p = 0.1610). DISCUSSION Teaching PA students how best to engage with adolescents can be done effectively via coached role-play.
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Affiliation(s)
- Tanya Fernandez
- Tanya Fernandez, MS, PA-C, is an assistant professor in the Department of Pediatrics, Child Health Associate/Physician Assistant Program, University of Colorado, Aurora, Colorado
- Paritosh Kaul, MD, is a professor of pediatrics and chief of Section of Adolescent Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paritosh Kaul
- Tanya Fernandez, MS, PA-C, is an assistant professor in the Department of Pediatrics, Child Health Associate/Physician Assistant Program, University of Colorado, Aurora, Colorado
- Paritosh Kaul, MD, is a professor of pediatrics and chief of Section of Adolescent Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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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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Jhe GB, Addison J, Lin J, Pluhar E. Pornography use among adolescents and the role of primary care. Fam Med Community Health 2023; 11:fmch-2022-001776. [PMID: 36650009 PMCID: PMC9853222 DOI: 10.1136/fmch-2022-001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/27/2022] [Indexed: 01/19/2023] Open
Abstract
Given the increase in pornography use among adolescents over the years, we discuss the impact of its use on sexual health development as well as the role of primary care providers (PCPs) in assessing use and providing sexual health education. While pornography use is often viewed negatively, it is important to develop unbiased understanding of the use in order to provide non-judgemental, adolescent-focused and educational care. As PCPs are often the first point of contact when adolescents experience medical and behavioural health concerns, it is essential for them to be equipped to screen for pornography use effectively, create a confidential and comfortable environment to talk about pornography use and sexuality, and be informed of ways to promote open discussion between youth and parents. In addition to PCP involvement, parental collaboration, knowledge and comfortability with discussing pornography use with their child are powerful tools in understanding and navigating pornography use in this population. This special communication seeks to provide an objective view of adolescents' pornography use, guidelines for screening of pornography use and ways to facilitate conversations about the use between adolescents and caregivers.
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Affiliation(s)
- Grace B Jhe
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA .,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jessica Addison
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Jessica Lin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily Pluhar
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA,Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA,Division of Sports Medicine, Boston Children’s Hospital, Boston, MA, USA
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Lian Q, Lou C, Zhong X, Zhang J, Tu X, Fang Y, Yu C, Zuo X. Nonconforming gender expression and insufficient sleep among adolescents during COVID-19 school closure and after school reopening. BMC Public Health 2022; 22:2037. [PMCID: PMC9640811 DOI: 10.1186/s12889-022-14463-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Gender nonconformity (GNC) (i.e., gender expression that differs from gender role expectations for feminine or masculine appearance and behavior) is an under-researched area of adolescent sleep health. The COVID-19 lockdown offers an opportunity to understand how the effect of GNC on adolescent health outcomes changes between school closure and reopening.
Methods
We conducted a cross-sectional study in Shanghai, China, in 2020. The sample size for analysis was 3,265. The age-specific insufficient sleep was estimated according to National Sleep Foundation's sleep duration recommendations. The self-perceived and self-rated GNC were measured by the two items “On the same scale that goes from 100% as a girl to 100% as a boy, where do you think others see you?” and “On a scale that goes from feeling 100% like a girl to feeling 100% like a boy, where do you see yourself?”, and birth sex. In addition, we calculated sex-stratified adjusted odds ratios (AORs) of insufficient sleep for students with high and moderate GNC compared to students with low GNC. Finally, we measured the AORs with self-perceived and self-rated GNC during COVID-19 school closure and reopening.
Results
Among 3,265 students in grade 6–12 in the analytic sample, 1,567(48.0%) were assigned female at birth (AFAB), 3,188 (97.6%) Han, and 1,921(58.8%) in grade 6–9. Among AFAB students, high self-perceived GNC was significantly associated with insufficient sleep (AOR,1.65; 95%CI,1.30–2.09) during school closure. Insufficient sleep was associated with high self-rated GNC (AOR,1.73; 95%CI,1.23–2.44) and moderate self-rated GNC (AOR,1.69; 95%CI,1.29–2.22) during school closure. After school reopening, neither self-perceived nor self-rated GNC was associated with insufficient sleep among AFAB students. Among assigned male at birth (AMAB) students, none of the two kinds of GNC was associated with insufficient sleep in the two periods during the COVID-19 pandemic.
Conclusions
This study suggests GNC is only associated with insufficient sleep among AFAB students during school closure. Furthermore, the association is nonsignificant among AMAB students. These findings indicate that GNC-related stigma within the family could be a risk factor for insufficient sleep among AFAB adolescents.
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Klein JD, Resnick EA, Danawala S, Grilo SA, Catallozzi M, Li B, Gorzkowski J, Kaseeska K, Santelli JS. Receipt of Private Time Among Adolescents and Young Adults With and Without Special Healthcare Needs. J Adolesc Health 2022; 70:414-420. [PMID: 35033426 DOI: 10.1016/j.jadohealth.2021.10.014] [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: 04/28/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Private time is an opportunity for the adolescent patient to speak directly to a healthcare provider and a marker of quality preventive health care. Little is known about whether adolescents and young adults (AYAs) with special healthcare needs (SHCNs) are afforded private discussions with their primary care clinicians. METHODS We surveyed a nationally representative sample of 1,209 adolescents (13-18 years) and 709 young adults (19-26 years) about whether they had SHCNs and whether they had ever had private, one-on-one time with their healthcare providers. RESULTS SHCNs were reported by 20.3% of adolescents and 15.6% of young adults. Among adolescents, older age was associated with more SHCNs. Among young adults, women and blacks were more likely to report SHCNs than men and those reporting other race categories. For both AYAs, those with SHCNs more often received private time than those without SHCNs: 54.2% of adolescents and 88.1% of young adults with SHCNs reported ever having received private time, compared with 29.6% of adolescents and 62.1% of young adults without SHCNs. CONCLUSIONS Lack of private time continues to impact quality primary care for AYAs; however, AYAs with SHCNs are more likely to have received private time than AYAs who do not have SHCNs. Further research is needed to understand whether increased number of clinical visits, clinician-related factors, or other factors lead to more opportunities for young people with SHCNs to receive private time from their clinicians.
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Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.
| | - Elissa A Resnick
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Sejal Danawala
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois
| | - Stephanie A Grilo
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Marina Catallozzi
- Departments of Population & Family Health and Pediatrics, Columbia University, New York, New York
| | - Boxuan Li
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - 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
| | - John S Santelli
- Departments of Population & Family Health and Pediatrics, Columbia University, New York, New York
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Hsu KK, Rakhmanina NY. Adolescents and Young Adults: The Pediatrician's Role in HIV Testing and Pre- and Postexposure HIV Prophylaxis. Pediatrics 2022; 149:183848. [PMID: 34972226 PMCID: PMC9645702 DOI: 10.1542/peds.2021-055207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.
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Affiliation(s)
- Katherine K Hsu
- Division of STD Prevention and HIV/AIDS Surveillance, Massachusetts Department of Public Health, Jamaica Plain, Massachusetts,Section of Pediatric Infectious Diseases, Boston University Medical Center, Boston, Massachusetts,Address correspondence to Katherine K. Hsu, MD, MPH, FAAP. E-mail:
| | - Natella Yurievna Rakhmanina
- Children’s National Hospital, School of Medicine and Health Sciences, The George Washington University, Washington, DC,Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC
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Berlan E, Valenti O, Long W, Toth C, Abenaim A, Maciejewski H, Gowda C. Practice Facilitation Improves Adolescent Reproductive Health Preventive Services in Primary Care. Pediatrics 2022; 149:183863. [PMID: 34972227 DOI: 10.1542/peds.2020-035774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Provision of reproductive health preventive services to adolescents is critical given their high rates of sexually transmitted infections and unintended pregnancies. Pediatricians are well positioned to provide these services but often face barriers. With this project, we aimed to build quality improvement (QI) capacity within pediatric practices to improve adherence to national guidelines for adolescent reproductive health preventive services. METHODS In 2016, an accountable care organization overseeing health care delivery for low-income children in the Midwestern United States used practice facilitation, a proven approach to improve health care quality, to support pediatric practices in implementing reproductive health QI projects. Interested practices pursued projects aimed at providing (1) sexual risk reduction and contraceptive counseling (reproductive health assessments [RHAs]) or (2) etonogestrel implants. QI specialists helped practices build key driver diagrams and implement interventions. Outcome measures included the proportion of well-care visits with RHAs completed and number of etonogestrel insertions performed monthly. RESULTS Between November 1, 2016, and December 31, 2019, 6 practices serving >7000 adolescents pursued QI projects. Among practices focused on RHAs, the proportion of well-care visits with completed RHAs per month increased from 0% to 65.8% (P < .001) within 18 months. Among practices focused on etonogestrel implant insertions, overall insertions per month increased from 0 to 8.5 (P < .001). CONCLUSIONS Practice facilitation is an effective way to increase adherence to national guidelines for adolescent reproductive health preventive services within primary care practices. Success was driven by practice-specific customization of interventions and ongoing, hands-on support.
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Affiliation(s)
- Elise Berlan
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and
| | - Olivia Valenti
- Nationwide Children's Hospital, Columbus, Ohio.,Partners For Kids, Columbus, Ohio
| | - William Long
- Nationwide Children's Hospital, Columbus, Ohio.,Partners For Kids, Columbus, Ohio
| | | | | | - Heather Maciejewski
- Nationwide Children's Hospital, Columbus, Ohio.,Partners For Kids, Columbus, Ohio
| | - Charitha Gowda
- Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio; and.,Partners For Kids, Columbus, Ohio
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Lanteigne A, Genest M, Racine E. The evaluation of pediatric-adult transition programs: What place for human flourishing? SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Fakeye OA, Khanna N, Hsu YJ, Marsteller JA. Impact of a Statewide Multi-Payer Patient-Centered Medical Home Program on Antihypertensive Medication Adherence. Popul Health Manag 2021; 25:309-316. [PMID: 34609933 DOI: 10.1089/pop.2021.0172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Evidence suggests that the patient-centered medical home (PCMH) model of primary care improves management of chronic disease, but there is limited research contrasting this model's effect when financed by a single payer versus multiple payers, and among patients with different types of health insurance. This study evaluates the impact of a statewide medical home demonstration, the Maryland Multi-Payer PCMH Program (MMPP), on adherence to antihypertensive medication therapy relative to non-PCMH primary care and to the PCMH model when financed by a single payer. The authors used a difference-in-differences analytic design to analyze changes in medication possession ratio for antihypertensive medications among Medicaid-insured and privately insured non-elderly adult patients attributed to primary care practices in the MMPP ("multi-payer PCMHs"), medical homes in Maryland that participated in a regional PCMH program funded by a single private payer ("single-payer PCMHs"), and non-PCMH practices in Maryland. Comparison sites were matched to multi-payer PCMHs using propensity scores based on practice characteristics, location, and aggregated provider characteristics. Multi-payer PCMHs performed better on antihypertensive medication adherence for both Medicaid-insured and privately insured patients relative to single-payer PCMHs. Statistically significant effects were not observed consistently until the second year of the demonstration. There were negligible differences in outcome trends between multi-payer medical homes and matched non-PCMH practices. Findings indicate that health care delivery innovations may yield superior population health outcomes under multi-payer financing compared to when such initiatives are financed by a single payer.
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Affiliation(s)
- Oludolapo A Fakeye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Niharika Khanna
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Reisner SL, Mateo C, Elliott MN, Tortolero S, Davies SL, Lewis T, Li D, Schuster M. Analysis of Reported Health Care Use by Sexual Orientation Among Youth. JAMA Netw Open 2021; 4:e2124647. [PMID: 34714346 PMCID: PMC8556619 DOI: 10.1001/jamanetworkopen.2021.24647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE In the United States, adolescents who are lesbian, gay, or bisexual (LGB) face disparities across physical and mental health outcomes compared with non-LGB youth, yet few studies have looked at patterns of health care utilization by sexual orientation. OBJECTIVE To compare health care utilization indicators for LGB and non-LGB youth. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed wave 3 data from Healthy Passages, a longitudinal observational study of diverse public school students in Birmingham, Alabama; Houston, Texas; and Los Angeles County, California. Multivariable logistic regression models tested sexual-orientation differences in the past 12-month health care utilization measures, controlling for youth age, gender, race and ethnicity, household education, income, and marital status. Data collection began in 2010 when students were in the 5th grade (mean [SE] age, 11.13 [0.01] years) (wave 1) and continued 2 years later (wave 2, 7th grade) and 5 years later (wave 3, 10th grade). Permission to be contacted was provided for 6663 children, and 5147 (77%) participated in audio computer-assisted self-administered interviews. This study included 4256 youth (640 LGB, 3616 non-LGB) who completed interviews at wave 1 and wave 3 and answered key items used in this analysis. Analyses were completed in June 2021. EXPOSURES Sexual orientation (LGB vs non-LGB). MAIN OUTCOMES AND MEASURES Health care utilization and communication difficulty with a physician in the past 12 months. RESULTS Among 4256 youths included in the study at baseline in 5th grade (wave 1), 2171 (48.9%) were female; 1502 (44.5%) were Hispanic or Latino; 1479 (28.9%) were Black; the mean (SE) age was 11.19 (0.03) years; and 640 (14.5%) were LGB at wave 3. Compared with non-LGB youth, a higher proportion of LGB youth reported not receiving needed medical care in the last 12 months (adjusted odds ratio [aOR], 1.68; 95% CI,1.38-2.05), most commonly for sexually transmitted infections, contraception, and substance use. LGB youth more frequently reported difficulty communicating with their physician (aOR, 1.71; 95% CI, 1.27-2.30) than non-LGB youth. CONCLUSIONS AND RELEVANCE This study's results found that health care utilization differs by sexual orientation for youth. These findings suggest that clinician training is needed to address the health care needs of LGB youth. Routinely capturing sexual orientation data might enable tracking of health care utilization indicators for LGB youth.
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Affiliation(s)
- Sari L. Reisner
- Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Division of Endocrinology, Diabetes & Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Camila Mateo
- Pediatrics, Boston Children's Hospital, Boston, Massachusetts
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | | | - Dennis Li
- Northwestern University, Evanston, Illinois
| | - Mark Schuster
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
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Henzler M, Trzos K, Głuchowska J, Pietruszkiewicz M, Nitsch‐Osuch A, Bogdan M. Polish adolescents' right to confidential primary health care is not respected despite high public acceptance. Acta Paediatr 2021; 110:2850-2855. [PMID: 34160862 DOI: 10.1111/apa.16001] [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: 03/15/2021] [Revised: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
AIM The right of underaged patients to confidential health care should be considered an inalienable human right. Access to such care is also advisable according to contemporary medical knowledge. The aim of this study was to verify the extent this right is exercised in Poland and to examine social attitudes towards this issue. METHODS A sample of Polish school-age pupils and parents (n = 800) was surveyed using an online questionnaire. RESULTS Only 4.2% of the surveyed adolescents were offered private time with a doctor during their last preventive visit (well-child visit), and this was more frequent for girls. At the same time, a very high level of acceptance for private time with a doctor was observed among Polish adolescents (90.8%) and their parents (84.3%). CONCLUSION Our findings suggest serious deficiencies in the protection of adolescent patients confidentiality. It is necessary to change medical practice and adapt legal regulations to the provisions of the Convention on the Rights of the Child.
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Affiliation(s)
- Michał Henzler
- Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland
| | - Katarzyna Trzos
- Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland
| | - Julia Głuchowska
- Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland
| | - Maksym Pietruszkiewicz
- Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland
| | - Aneta Nitsch‐Osuch
- Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland
| | - Magdalena Bogdan
- Department of Social Medicine and Public Health Medical University of Warsaw Warsaw Poland
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Rastogi R, Rome ES. Adolescent Gynecology in the Office Setting. Pediatr Rev 2021; 42:427-438. [PMID: 34341084 DOI: 10.1542/pir.2019-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Ensuring open communication, partnership with patient and parent, and clarification of confidentiality during an adolescent gynecologic visit helps establish an environment in which a history and physical examination can be performed safely and with a focus on prevention, recognition of disease, and treatment as necessary. The history should include the menstrual status and gynecologic review of systems. The examination should document Tanner staging (sexual maturity rating) and be otherwise symptom guided. Similarly, testing in the office is largely risk and symptom related. Contraceptive counseling is an important component of the office visit, as well. Long and short curricula for teaching pediatric and adolescent gynecology have been developed by the North American Society for Pediatric and Adolescent Gynecology and are readily available for use. (1)(2) Although state-based variation in consent and confidentiality exists, pediatric practices should aim to protect patient confidentiality and transition to more independent health-care decision making.
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Affiliation(s)
- Radhika Rastogi
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Ellen S Rome
- Center for Adolescent Medicine, Cleveland Clinic Children's Hospital, Department of Pediatric Endocrinology, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH
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18
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Nitiyarom R, Banomyong N, Wisuthsarewong W. Knowledge about, attitude toward, and practices in skin care among Thai adolescents. J Cosmet Dermatol 2021; 21:1539-1546. [PMID: 34153166 DOI: 10.1111/jocd.14309] [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: 04/23/2021] [Accepted: 06/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Skin care for maintaining skin integrity includes cleansing, skin product use, and photoprotection. Inappropriate skin care can lead to skin problems. AIMS To evaluate the knowledge, attitude, and practices in skin care among Thai adolescents. PATIENTS/METHODS Questionnaire-based, descriptive, cross-sectional study. RESULTS A total of 588 Thai adolescent students (mean age: 15.6 ± 1.8 years, 50.5% female) were included. Of those who responded, 99.5% knew the benefits of cleansing, and 95.9% knew the benefits of skin care products. Skin products, moisturizer, and sunscreen were used by 87.8%, 80.8%, and 71.5% of students, respectively. Female teenagers used moisturizers, cosmetics, and sunscreen significantly more than males (p = 0.001, p = 0.001, and p < 0.001, respectively). High school teenagers applied cosmetics more than junior high school teenagers (p = 0.004). Ninety-three percent of adolescents knew the effects of sunlight, but only 27.4% regularly applied sunscreen. The sources of knowledge were from person, online social media, print media, and television/radio in 88.5%, 77.5%, 30.7%, and 26.1%, respectively. Data from physicians and parents were trusted by 65.3% and 64.2%, respectively. Most (74.1%) adolescents searched for data from more than 1 source. Adolescent females and high school adolescents demonstrated significantly more accurate knowledge and practice in cleansing and photoprotection (p < 0.001) compared with adolescent males and junior high school adolescents. Knowledge and practices did not significantly correlate with underlying skin diseases or monthly allowance. CONCLUSION Gender and education level were found to significantly influence knowledge and practice in skin care among adolescents in Thailand.
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Affiliation(s)
- Rattanavalai Nitiyarom
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Narin Banomyong
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanee Wisuthsarewong
- Division of Dermatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Schraeder K, Dimitropoulos G, Allemang B, McBrien K, Samuel S. Strategies for improving primary care for adolescents and young adults transitioning from pediatric services: perspectives of Canadian primary health care professionals. Fam Pract 2021; 38:329-338. [PMID: 33128378 PMCID: PMC8211142 DOI: 10.1093/fampra/cmaa113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family physicians and other members of the primary health care (PHC) team may be ideally positioned to provide transition care to adolescents and young adults (AYAs; aged 12-25 years) exiting pediatric specialty services. Potential solutions to well-known challenges associated with integrating PHC and specialty care need to be explored. OBJECTIVE To identify strategies to transition care by PHC professionals for AYAs with chronic conditions transitioning from pediatric to adult-oriented care. METHODS Participants were recruited from six Primary Care Networks in Calgary, Alberta. A total of 18 semi-structured individual interviews were completed, and transcribed verbatim. Data were analyzed using a qualitative description approach, involving thematic analysis. RESULTS Participants offered a range of strategies for supporting AYAs with chronic conditions. Our analysis resulted in three overarching themes: (i) educating AYAs, families, and providers about the critical role of primary care; (ii) adapting existing primary care supports for AYAs and (iii) designing new tools or primary care practices for transition care. CONCLUSIONS Ongoing and continuous primary care is important for AYAs involved with specialty pediatric services. Participants highlighted a need to educate AYAs, families and providers about the critical role of PHC. Solutions to improve collaboration between PHC and pediatric specialist providers would benefit from additional perspectives from providers, AYAs and families. These findings will inform the development of a primary care-based intervention to improve transitional care.
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Affiliation(s)
| | - Gina Dimitropoulos
- Faculty of Social Work
- Mathison Centre for Mental Health Research & Education
| | | | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine
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20
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Gordon AR, Austin SB, Schultz J, Guss CE, Calzo JP, Wang ML. Gender Expression, Peer Victimization, and Disordered Weight-Control Behaviors Among U.S. High School Students. J Adolesc Health 2021; 68:1148-1154. [PMID: 33071166 PMCID: PMC8756556 DOI: 10.1016/j.jadohealth.2020.08.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/31/2020] [Accepted: 08/28/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study is to examine the association between gender expression, peer victimization, and disordered weight-control behaviors (DWCBs) in four population-based samples of U.S. high school students. METHODS Analyses include data from 5,488 U.S. high school students from the 2013 Youth Risk Behavior Surveys in four jurisdictions (Broward County, FL; Chicago, IL; Los Angeles, CA; San Diego, CA). Participants were 56% Hispanic/Latino, 21% black/African American, and 14% white. Two items asked about perceived gender expression; responses were classified into three groups: highly gender conforming (e.g., very masculine boys), moderately gender conforming, gender nonconforming (e.g., feminine boys). Sex-stratified multivariable logistic regression models were used to examine the association between gender expression, peer victimization, and DWCBs in previous month (fasting, using diet pills/liquids/powders, and purging [vomiting or using laxatives]), controlling for potential confounders. RESULTS Overall, 12% of respondents reported fasting, 6% reported diet pill use, and 5% reported purging, with significantly higher prevalence among gender nonconforming than among gender conforming male students (p < .001). In adjusted models, gender nonconforming male students had greater odds of fasting (odds ratio [95% confidence interval]: 3.0 [2.0-4.7]), diet pill use (6.1 [3.7-9.9]), and purging (7.2 [3.6-14.8]), relative to moderately conforming males. No significant associations were found among female students. Adding peer victimization to models modestly attenuated the association between gender nonconformity and DWCBs for male students. CONCLUSIONS In probability samples of U.S. high school students, we observed marked differences by gender expression in DWCBs among male students but not among female students. Gender expression-related stigma should be addressed within clinical and school-based interventions to prevent DWCBs.
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Affiliation(s)
- Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
| | - S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Department of Social & Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jordan Schultz
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Carly E Guss
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jerel P Calzo
- Division of Health Promotion & Behavioral Science, San Diego State University Graduate School of Public Health, San Diego, California; Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, California
| | - Monica L Wang
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
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Kirkpatrick L, Michel HK, Close A, Collins A, Miller E, Kazmerski TM. Pediatric Subspecialists' Practices and Attitudes Regarding Sexual and Reproductive Healthcare for Adolescent and Young Adult Women Prescribed Teratogenic Medications. J Pediatr 2021; 233:227-232.e2. [PMID: 33545192 DOI: 10.1016/j.jpeds.2021.01.066] [Citation(s) in RCA: 4] [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: 06/13/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate pediatric subspecialists' practices and attitudes regarding sexual and reproductive healthcare for adolescent and young adult women for whom they prescribe teratogens. STUDY DESIGN We surveyed pediatric subspecialists at 1 tertiary care pediatric hospital. Items assessed attitudes and practices related to sexual and reproductive healthcare for adolescent and young adult women prescribed teratogens, and barriers and facilitators to sexual and reproductive healthcare provision. We used descriptive statistics, χ2 tests, and logistic regression to analyze results. RESULTS There were 200 subspecialists from 17 subspecialties who completed the survey; 77% reported prescribing teratogens to adolescent and young adult women and 18% reported caring for a patient who became pregnant while taking a teratogen. Overall, 99% indicated that it is important to address sexual and reproductive healthcare. Respondents endorsed confidence in sexual and reproductive healthcare skills, including contraceptive counseling (71%), although 29% never or rarely discuss sexual and reproductive healthcare, and one-third never speak privately to this population. Of providers who discuss sexual and reproductive healthcare, 26% never assess reproductive intentions and 36% do so less often than annually. Nearly one-half never or rarely ask about sexual activity, and 68% never or rarely assess contraceptive knowledge. Barriers to sexual and reproductive healthcare provision included available time (80%) and the presence of family or partners at clinic visits (61%). Facilitators included a quick referral process to sexual and reproductive healthcare providers (92%) and access to lists of local sexual and reproductive healthcare providers (90%). CONCLUSIONS Pediatric subspecialists from a single institution report suboptimal sexual and reproductive healthcare provision for adolescent and young adult women prescribed teratogens. Identified barriers and facilitators may guide intervention development to improve sexual and reproductive healthcare for this population.
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Affiliation(s)
- Laura Kirkpatrick
- Division of Child Neurology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
| | - Hilary K Michel
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Columbus, OH
| | - Allison Close
- Division of Hematology/Oncology, Helen DeVos Children's Hospital, Grand Rapids, MI
| | - Amy Collins
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Traci M Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA; Center for Women's Health Research and Innovation, University of Pittsburgh, Pittsburgh, PA
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22
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Diagnosis of Opioid Use Disorder by Youths Assessed in Acute Care Settings in British Columbia, Canada. J Pediatr 2021; 232:243-250. [PMID: 33515555 DOI: 10.1016/j.jpeds.2021.01.046] [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: 07/11/2020] [Revised: 11/04/2020] [Accepted: 01/20/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To describe trends in the number of youths diagnosed with opioid use disorder (OUD) and to identify factors associated with OUD diagnosis in acute care settings. STUDY DESIGN Data from a population-based retrospective cohort study with linkage of 6 health administrative databases for 13 009 youth age 12-24 years identified with OUD between 2001 and 2018 in British Columbia, Canada were used to describe annual diagnoses. Using a multiple logistic regression model, we estimated the association between past-year health care utilization and OUD diagnosis in acute settings, controlling for sociodemographic and OUD-related comorbid conditions. RESULTS Annual OUD diagnoses quadrupled between 2003 and 2017 (from 326 to 1473). Among the 6579 youth diagnosed with OUD between April 1, 2013 and September 30, 2018, 88.1% had past-year health system contacts. Youth age 12-18 had higher odds of OUD diagnosis in acute care (aOR 2.04; 95% CI 1.78, 2.34). Compared with no health care contact, youth receiving outpatient care only were less likely to be diagnosed with OUD in acute care (aOR 0.69; 95% CI 0.56, 0.84) and those with >1 urgent hospitalization were more likely to be diagnosed with OUD in acute care (aOR 1.87; 95% CI 1.40,2.49). CONCLUSIONS More than 88% of youth had past-year health system contacts prior to diagnosis. Those age 12-18 years and with urgent hospitalizations in the year prior to diagnosis were more likely to have OUD diagnosed in acute care settings. Establishing an effective evidence-based system for early detection and intervention among youth with OUD must be a priority.
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23
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Pfaff N, DaSilva A, Ozer E, Vemula Kaiser S. Adolescent Risk Behavior Screening and Interventions in Hospital Settings: A Scoping Review. Pediatrics 2021; 147:peds.2020-020610. [PMID: 33785635 DOI: 10.1542/peds.2020-020610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Risky behaviors are the main threats to adolescents' health; consequently, evidence-based guidelines recommend annual comprehensive risk behavior screening. OBJECTIVE To review studies of adolescent risk behavior screening and interventions in urgent care, emergency department (ED), and hospital settings. DATA SOURCES Our data sources included PubMed (1965-2019) and Embase (1947-2019). STUDY SELECTION Studies were included on the basis of population (adolescents aged 10-25 years), topic (risk behavior screening or intervention), and setting (urgent care, ED, or hospital). Studies were excluded if they involved younger children or adults or only included previously identified high-risk adolescents. DATA EXTRACTION Data extracted were risk behavior screening rates, screening and intervention tools, and attitudes toward screening and intervention. RESULTS Forty-six studies were included; most (38 of 46) took place in the ED, and a single risk behavior domain was examined (sexual health [19 of 46], mood and suicidal ideation [12 of 46], substance use [7 of 46], and violence [2 of 46]). In 6 studies, authors examined comprehensive risk behavior screening, demonstrating low rates at baseline (∼10%) but significant increases with clinician reminder implementation. Adolescents and clinicians were highly accepting of risk behavior screening in all settings and preferred electronic screening over a face-to-face interview. Reported barriers were time constraints and limited resources. LIMITATIONS Only 1 included study was a randomized controlled trial, and there was large heterogeneity of included studies, potentially limiting generalizability. CONCLUSIONS Rates of adolescent risk behavior screening are low in urgent care, ED, and hospital settings. Our findings outline promising tools for improving screening and intervention, highlighting the critical need for continued development and testing of interventions in these settings to improve adolescent care.
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Affiliation(s)
| | | | - Elizabeth Ozer
- Division of Adolescent and Young Adult Medicine.,Office of Diversity and Outreach, and
| | - Sunitha Vemula Kaiser
- Departments of Pediatrics and.,Epidemiology and Biostatistics.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California
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24
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Pageler NM, Webber EC, Lund DP. Implications of the 21st Century Cures Act in Pediatrics. Pediatrics 2021; 147:peds.2020-034199. [PMID: 33293349 DOI: 10.1542/peds.2020-034199] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Natalie M Pageler
- Stanford Children's Hospital, Stanford, California; .,Departments of Pediatrics and
| | - Emily C Webber
- Riley Hospital for Children, Indianapolis, Indiana; and.,Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Dennis P Lund
- Stanford Children's Hospital, Stanford, California.,Surgery, School of Medicine, Stanford University, Stanford, California
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25
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Clary K, Cortright L, Tumin D, Buckman C, Eldridge D. Primary Care Use and Assessment of Adolescents' Sexual Health During Hospitalization. Hosp Pediatr 2020; 10:963-968. [PMID: 33067349 DOI: 10.1542/hpeds.2020-0050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Hospitalization provides an opportunity to address sexual health needs of adolescents who may not otherwise receive regular medical care. We investigated documentation of a sexual health discussion with adolescents hospitalized at our medical center to determine if previous primary care physician (PCP) visits in the same health system were associated with sexual health documentation during the hospital admission. METHODS We retrospectively identified adolescents aged 13 to 17 years discharged from the pediatric general ward. Documented discussion of sexual health was reviewed in the electronic medical record. Previous PCP visits were identified from the affiliated primary care clinics within 12 months before hospitalization. We also queried follow-up PCP visits within 90 days of discharge to determine if a sexual health discussion during hospitalization was followed-up in the outpatient setting. RESULTS We analyzed 394 patients (49% girls; median age 15 years), of whom 122 (31%) had documentation of a sexual health discussion while hospitalized and 75 (19%) had previous PCP visits in our health system. On multivariable analysis, older age (P < .001), female sex (P = .016), admission from the emergency department (P < .001), and a genitourinary primary problem at admission (P = .007), but not previous PCP visits, were associated with increased likelihood of sexual health documentation. CONCLUSIONS Although discussion of sexual health was uncommon overall for hospitalized adolescents, we noted that nearly 4 in 5 adolescents for whom this was documented had not recently visited a PCP in our health system. These findings highlight hospitalization as a unique opportunity for sexual health intervention among adolescents who may not regularly see a PCP.
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Affiliation(s)
- Kathryn Clary
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
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26
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Thomsen EL, Hertz PG, Blix C, Boisen KA. A national guideline for youth-friendly health services developed by chronically ill young people and health care professionals - a Delphi study. Int J Adolesc Med Health 2020; 34:487-498. [PMID: 32877363 DOI: 10.1515/ijamh-2020-0185] [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] [Received: 07/17/2020] [Accepted: 08/02/2020] [Indexed: 11/15/2022]
Abstract
Objectives Significant variation in cultural and socio-economic factors across different countries means that modification of existing guidelines for youth-friendly health services are needed. Furthermore, including the views and perspectives of young people in developing health services add significant value. The aim of this study was to develop a national guideline for youth-friendly health services using the Delphi method. Methods We invited young people with chronic conditions, managers of paediatric, psychiatric and relevant adult departments and health care professionals with experience and interest in adolescent medicine to participate. The initial list of elements was constructed based on international guidelines and systematic reviews. The study consisted of three electronic questionnaire rounds assessing relevance, importance and whether the elements were essential/very important, respectively. We used 70% agreement as cut-off. Results More than 70% of participants agreed that only one element was essential: 'Young people should be actively involved in decisions about their treatment and encouraged and supported to ask questions about their illness and treatment'. Additionally, 18 elements reached more than 70% agreement, when the 'essential' was combined with the 'very important' category. We grouped these 19 elements into five themes: 1) staff competences and workflow, 2) developmentally appropriate communication, 3) focus on youth life, including mental health 4) youth participation and shared decisions, and 5) autonomy and transitional care. Conclusion This guideline for a youth-friendly health care system may serve as inspiration for concrete changes, both locally and internationally, as it was developed together by young people, staff, and management.
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Affiliation(s)
- Ena Lindhart Thomsen
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Pernille Grarup Hertz
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Blix
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kirsten A Boisen
- Department of Pediatric and Adolescent Medicine, Center of Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Adkins SH, Anderson KN, Goodman AB, Twentyman E, Danielson ML, Kimball A, Click ES, Ko JY, Evans ME, Weissman DN, Melstrom P, Kiernan E, Krishnasamy V, Rose DA, Jones CM, King BA, Ellington SR, Pollack LA, Wiltz JL. Demographics, Substance Use Behaviors, and Clinical Characteristics of Adolescents With e-Cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) in the United States in 2019. JAMA Pediatr 2020; 174:e200756. [PMID: 32421164 PMCID: PMC7235914 DOI: 10.1001/jamapediatrics.2020.0756] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE To date, limited information is available on the characteristics of adolescents with e-cigarette, or vaping, product use-associated lung injury (EVALI). OBJECTIVE To inform public health and clinical practice by describing differences in demographics, substance use behaviors, and clinical characteristics of EVALI among adolescents compared with adults. DESIGN, SETTING, AND PARTICIPANTS Surveillance data reported to the Centers for Disease Control and Prevention during the 2019 EVALI outbreak were used to calculate adjusted prevalence ratios (aPRs) with 95% CIs and to test differences between 360 hospitalized or deceased adolescents vs 859 young adults and 936 adults with EVALI (N = 2155). MAIN OUTCOMES AND MEASURES Demographics, substance use behaviors, and clinical characteristics. RESULTS Included in this cross-sectional study were 360 hospitalized or deceased adolescents (age range, 13-17 years; 67.9% male) vs 859 young adults (age range, 18-24 years; 72.4% male) and 936 adults (age range, 25-49 years; 65.6% male) with EVALI. Adolescents diagnosed as having EVALI reported using any nicotine-containing (62.4%), any tetrahydrocannabinol (THC)-containing (81.7%), and both (50.8%) types of e-cigarette or vaping products. Informal sources for obtaining nicotine-containing and THC-containing e-cigarette or vaping products were more commonly reported by adolescents (50.5% for nicotine and 96.5% for THC) than young adults (19.8% for nicotine [aPR, 2.49; 95% CI, 1.78-3.46] and 86.9% for THC [aPR, 1.11; 95% CI, 1.05-1.18]) or adults (24.3% for nicotine [aPR, 2.06; 95% CI, 1.49-2.84] and 75.1% for THC [aPR, 1.29; 95% CI, 1.19-1.40]). Mental, emotional, or behavioral disorders were commonly reported; a history of attention-deficit/hyperactivity disorder was almost 4 times more likely among adolescents (18.1%) than adults (4.9%) (aPR, 3.74; 95% CI, 1.92-7.26). A history of asthma was more likely to be reported among adolescents (43.6%) than adults (28.3%) (aPR, 1.53; 95% CI, 1.14-2.05). Gastrointestinal and constitutional symptoms were more common in adolescents (90.9% and 97.3%, respectively) than adults (75.3% and 94.5%, respectively) (aPR, 1.20; 95% CI, 1.13-1.28 and aPR, 1.03; 95% CI, 1.00-1.06, respectively). Because of missing data, percentages may not be able to be calculated from data provided. CONCLUSIONS AND RELEVANCE Public health and clinical professionals should continue to provide information to adolescents about the association between EVALI and THC-containing e-cigarette or vaping product use, especially those products obtained through informal sources, and that the use of any e-cigarette or vaping product is unsafe. Compared with adults, it appears that adolescents with EVALI more frequently have a history of asthma and mental, emotional, or behavioral disorders, such as attention-deficit/hyperactivity disorder, and report nonspecific problems, including gastrointestinal and constitutional symptoms; therefore, obtaining a confidential substance use history that includes e-cigarette or vaping product use is recommended.
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Affiliation(s)
- Susan H. Adkins
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kayla N. Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alyson B. Goodman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Evelyn Twentyman
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Melissa L. Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anne Kimball
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor S. Click
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Mary E. Evans
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David N. Weissman
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Paul Melstrom
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Emily Kiernan
- Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vikram Krishnasamy
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dale A. Rose
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christopher M. Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A. King
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Sacha R. Ellington
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Lori A. Pollack
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
| | - Jennifer L. Wiltz
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Decatur, Georgia
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Coleman-Minahan K, Hopkins K, White K. Availability of Confidential Services for Teens Declined After the 2011-2013 Changes to Publicly Funded Family Planning Programs in Texas. J Adolesc Health 2020; 66:719-724. [PMID: 31974014 PMCID: PMC7263963 DOI: 10.1016/j.jadohealth.2019.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/05/2019] [Accepted: 12/04/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Texas is one of 24 states that does not explicitly allow minors to consent to contraception. We explore changes in the provision of confidential reproductive health services after the implementation of state policies that cut and reorganized public family planning funding, including Title X. METHODS We use data from 3 waves of in-depth interviews, conducted between February 2012 and February 2015, with program administrators at publicly funded family planning organizations in Texas about changes in service delivery. We conducted a thematic analysis of transcripts from 47 organizations with segments related to the provision of services to minor teens. RESULTS Overall, 34 of the 47 organizations received Title X funding before 2013, and 79% lost this funding during the study period. Respondents at these organizations frequently reported a decrease in teen clients, which they attributed to loss of confidential services previously guaranteed under Title X. As the number of Title X-funded sites decreased, availability of confidential services became inconsistent. Most organizations offered confidential testing for pregnancy and sexually transmitted infections, but availability of confidential contraceptive services varied across and within organizations and often depended on insurance coverage. Respondents also reported challenges clarifying parental consent requirements after the changes in Title X and state funding. CONCLUSIONS Loss of Title X funding decreased availability of quality family planning services for teens and burdened organizations. As the new Title X regulations are implemented, family planning organizations' experiences in Texas foreshadow what might occur nationally, particularly in states that do not allow minors to consent for contraception.
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Affiliation(s)
- Kate Coleman-Minahan
- College of Nursing, Anschutz Medical Campus, University of Colorado, Aurora, Colorado; University of Colorado Population Center (CUPC), University of Colorado Boulder, Boulder, Colorado.
| | - Kristine Hopkins
- Population Research Center, University of Texas at Austin, Austin, Texas
| | - Kari White
- Population Research Center, University of Texas at Austin, Austin, Texas; Department of Sociology, University of Texas at Austin, Austin, Texas; Steve Hicks School of Social Work, University of Texas at Austin, Austin, Texas
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Abstract
It is crucial that all children are provided with high-quality and safe health care. Pediatric inpatient needs are unique in regard to policies, equipment, facilities, and personnel. The intent of this clinical report is to provide recommendations for the resources necessary to provide high-quality and safe pediatric inpatient medical care.
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Affiliation(s)
- Kimberly D Ernst
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma
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Levy S, Seale JP, Alford DP. Medicine, with a focus on physicians: Addressing substance use in the 21st century. Subst Abus 2019; 40:396-404. [DOI: 10.1080/08897077.2019.1691130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Sharon Levy
- Director, Adolescent Substance Use and Addiction Program, Boston Children’s Hospital, Boston, Masachussetts, USA
| | - J. Paul Seale
- School of Medicine, Navicent Health and Mercer University School of Medicine, Macon, Georgia, USA
| | - Daniel P. Alford
- Boston University School of Medicine, Boston Medical Center, Boston, Masachussetts, USA
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Pilgrim NA, Jennings JM, Sanders R, Page KR, Loosier PS, Dittus PJ, Marcell AV. Understanding Quality of Care and Satisfaction With Sexual and Reproductive Healthcare Among Young Men. J Healthc Qual 2019; 40:354-366. [PMID: 30399033 PMCID: PMC6224152 DOI: 10.1097/jhq.0000000000000149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Sexual and reproductive healthcare (SRHC) guidelines recommend the delivery of quality preventive SRHC to males beginning in adolescence. A quality of care (QOC) framework was used to examine factors associated with young male's perceptions of QOC and satisfaction with care, which can influence their engagement and use of SRHC. METHODS Cross-sectional surveys were conducted from August 2014 to September 2016 with 385 male patients aged 15-24 years, recruited from primary care and sexually transmitted disease (STD) clinics. Surveys measured QOC received, satisfaction with care, and domains of a QOC framework. Poisson regression analyses examined associations between domains of quality and perceived QOC as well as satisfaction with care. RESULTS Over half of males reported QOC as excellent (59%) and were very satisfied with the services (56.7%). Excellent QOC and high satisfaction with services was associated with timely care, higher Clinician-Client Centeredness, and being a bisexual male. Excellent QOC was also associated with greater comfort in the clinic, being tested for human immunodeficiency virus/STDs, attending primary care settings, and receipt of higher number of SRHC services. CONCLUSIONS Using a QOC framework as part of providing SRHC to young males can be important in improving their perceptions of QOC and satisfaction with services.
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Knipper SH, Rivers W, Goodman JM. Effects of citizenship status, Latino ethnicity, and household language on health insurance coverage for U.S. adolescents, 2007-2016. Health Serv Res 2019; 54:1166-1173. [PMID: 31385302 DOI: 10.1111/1475-6773.13198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE/STUDY QUESTION To examine changes in uninsurance rates among U.S. adolescents ages 12-17 and assess whether trends over time differed by citizenship status, Latino ethnicity, and household language. DATA SOURCES/STUDY SETTING 2007-2016 National Health Insurance Survey (NHIS). STUDY DESIGN Multivariable logistic regression and postestimation marginal effects were used to assess changes in the current uninsured rate. Logistic regression models were used to determine significant trends over time for each demographic group and compare them to trends in the broader adolescent population. Marginal effects were employed to calculate adjusted outcome probabilities for each year. PRINCIPAL FINDINGS Across all 12- to 17-year-olds, the unadjusted uninsured rate dropped significantly between 2007 and 2016, from 10.2 percent to 6.0 percent. For noncitizen youth, the probability of being uninsured increased from 26.6 percent in 2007 to 28.4 percent in 2016, after controlling for covariates. Latino youth and those in Spanish-speaking households saw declines in their adjusted uninsurance rate that was proportional to non-Latino and English-speaking youth. CONCLUSIONS Most adolescents saw significant improvements in health insurance coverage between 2007 and 2016; however, disparities remain among Spanish-speaking and Latino adolescents and no improvements were seen among noncitizen youth. This suggests a need for equity-focused eligibility, outreach, and enrollment policies that expand insurance options for these populations.
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Wood D, Geoghegan S, Ramnarayan P, Davis PJ, Tume L, Pappachan JV, Goodwin S, Wray J. Where Should Critically Ill Adolescents Receive Care? A Qualitative Interview-Based Study of Perspectives of Staff Working in Adult and Pediatric Intensive Care Units. J Intensive Care Med 2019; 35:1271-1277. [PMID: 31189376 DOI: 10.1177/0885066619856573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE In the United Kingdom, critically ill adolescents are treated in either adult or pediatric intensive care units (AICUs or PICUs). This study explores staff perspectives on where and how best to care for this distinct group. MATERIALS AND METHODS Semistructured interviews were conducted with 12 members of staff (3 medical, 6 nursing, and 3 allied health professionals) working in 4 ICUs; 2 general hospital AICUs and 2 tertiary centre-based PICUs in England. Interviews were audio-recorded, transcribed, and analyzed using framework analysis. FINDINGS One overarching theme was identified, reflecting staff understanding of the term "adolescent," and this was linked to 2 further themes, each of which had several subthemes. "Needs of the critically ill adolescent" included medical needs, dignity and privacy, issues around consent, and the impact of intensive care admission. "Implications for staff" included managing parental presence and lack of familiarity, and emotional impact, of dealing with this patient group. Some of these factors are currently better accommodated in adult settings. CONCLUSIONS Decision-making about the place of care should take into account the individual circumstances of the patient (e.g., nature of their medical condition and previous experiences, maturity, family preference) and not be based only on age at admission. We should work across disciplines to ensure we can discover, and consistently deliver, best practice to meet the needs of critically ill adolescents.
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Affiliation(s)
- Dora Wood
- Paediatric Intensive Care Unit, 156596Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Sophie Geoghegan
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, 4956Great Ormond Street Hospital, London, United Kingdom
| | - Padmanabhan Ramnarayan
- Children's Acute Transport Service, 4956Great Ormond Street Hospital, London, United Kingdom.,Institute of Child Health, University College London, London, United Kingdom
| | - Peter J Davis
- Paediatric Intensive Care Unit, 156596Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Lyvonne Tume
- Faculty of Health, University of the West of England, Bristol, United Kingdom
| | - John V Pappachan
- Department of Paediatric Intensive Care, 7425 University Hospital Southampton, Southampton, United Kingdom
| | - Sarah Goodwin
- Paediatric Intensive Care Unit, 156596Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, 4956Great Ormond Street Hospital, London, United Kingdom.,Critical Care and Cardiorespiratory Division, 4956Great Ormond Street Hospital, London, United Kingdom.,NIHR Biomedical Research Centre, 4956Great Ormond Street Hospital, London, United Kingdom
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Hardin HK, McCarthy VL, Speck BJ, Crawford TN. Diminished Trust of Healthcare Providers, Risky Lifestyle Behaviors, and Low Use of Health Services: A Descriptive Study of Rural Adolescents. J Sch Nurs 2018; 34:458-467. [PMID: 28823198 PMCID: PMC5629118 DOI: 10.1177/1059840517725787] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of our study was to determine the extent to which individual characteristic variables predict trust of healthcare provider (HCP), lifestyle behaviors, and use of health services among adolescents attending public high school in rural Indiana. The sample included 224 individuals surveyed in 9th grade or 12th grade required courses. Trust of HCP and lifestyle behaviors were predicted using hierarchical multiple regression; number of HCP visits and emergency department (ED) visits in the past 12 months were predicted using negative binomial regression. This sample of adolescents living in a rural area reported riskier lifestyle behaviors than another sample of adolescents, lower trust of HCP than adults in general, and fewer HCP and ED visits than adolescents in general. Our study supports the need for school-based health services in rural areas and the opportunity for school nurses to act as care coordinators for marginalized youth.
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Affiliation(s)
- Heather K. Hardin
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Barbara J. Speck
- School of Nursing, University of Louisville, Louisville, KY, USA
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White PH, Cooley WC, Boudreau ADA, Cyr M, Davis BE, Dreyfus DE, Forlenza E, Friedland A, Greenlee C, Mann M, McManus M, Meleis AI, Pickler L. Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home. Pediatrics 2018; 142:peds.2018-2587. [PMID: 30348754 DOI: 10.1542/peds.2018-2587] [Citation(s) in RCA: 411] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Risk and vulnerability encompass many dimensions of the transition from adolescence to adulthood. Transition from pediatric, parent-supervised health care to more independent, patient-centered adult health care is no exception. The tenets and algorithm of the original 2011 clinical report, "Supporting the Health Care Transition from Adolescence to Adulthood in the Medical Home," are unchanged. This updated clinical report provides more practice-based quality improvement guidance on key elements of transition planning, transfer, and integration into adult care for all youth and young adults. It also includes new and updated sections on definition and guiding principles, the status of health care transition preparation among youth, barriers, outcome evidence, recommended health care transition processes and implementation strategies using quality improvement methods, special populations, education and training in pediatric onset conditions, and payment options. The clinical report also includes new recommendations pertaining to infrastructure, education and training, payment, and research.
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Affiliation(s)
- Patience H. White
- Got Transition/The National Alliance to Advance Adolescent Health and Department of Medicine and Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia; and
| | - W. Carl Cooley
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Gregg A, Chen LW, Kim J. Correlates of Patient-Centered Medical Home Recognition in School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2018; 88:830-838. [PMID: 30300927 DOI: 10.1111/josh.12689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/14/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The patient-centered medical home (PCMH) is promoted as a way to improve access to care, health care outcomes, and control costs. The organizational, environmental, and patient characteristics associated with school-based health centers (SBHCs) obtaining PCMH recognition is currently unknown. A multitheoretical approach was used to explore the correlates of formal PCMH recognition in SBHCs. METHODS The 2013-2014 National Census of School-Based Health Centers was used as the primary data source for this analysis. Multivariable logistic regression was used to assess the odds of an SBHC obtaining any type of PCMH recognition, and obtaining national PCMH recognition. RESULTS Only 29% of SBHCs had received any type of recognition as a PCMH and 17% reported receiving national-level recognition. School-based health centers that were managed care preferred providers, received Health Resources and Services Administration SBHC Capital Funding, and based in schools without adolescents had greater odds of both types of PCMH recognition outcomes. High levels of revenue from patient billing and more staff were also associated with national PCMH recognition. CONCLUSIONS Financial and personnel resources are needed for national-level PCMH recognition, and managed care is supportive of PCMH implementation. Efforts should be made to increase medical home activity in SBHCs that serve adolescents.
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Affiliation(s)
- Abbey Gregg
- Department of Community Medicine and Population Health, Institute for Rural Health Research, The University of Alabama University of Alabama, 1127 Northeast Medical Building, Tuscaloosa, AL 35487
| | - Li-Wu Chen
- Department of Health Services Research and Administration, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350
| | - Jungyoon Kim
- Department of Health Services Research and Administration, University of Nebraska Medical Center, 984350 Nebraska Medical Center, Omaha, NE 68198-4350
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Kaul P, Fisher JH, Hanson JL. Medical Students' Acquisition of Adolescent Interview Skills after Coached Role Play. J Pediatr Adolesc Gynecol 2018; 31:102-106. [PMID: 29175430 DOI: 10.1016/j.jpag.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/07/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
STUDY OBJECTIVE To develop and evaluate an educational activity designed to teach the adolescent Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety (HEADS) examination. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Participants were third-year medical students in their pediatric clerkships. Students received an article on the HEADS interview and attended an adolescent medicine educational session. The session included individualized goal-setting and coached role play. Students' skills in doing a HEADS interview were evaluated through a standardized patient encounter (SPE) with a checklist and a retrospective pre- and post-test survey. The SPE checklist was used to assess whether the students included questions in 6 key areas of a HEADS interview. RESULTS One hundred fifty-two students participated. During the SPE, 90% of students queried the adolescent's home life, 91% education, 82% activities, 84% drug/substance abuse, 95% sexual history, and 61% symptoms of depression. Pre- and postintervention data were compared using the Kruskal-Wallis Test and showed a statistically significant difference in the students' ability to list key topic areas of the HEADS exam (P < .001) and to use the skills needed for an adolescent interview using the HEADS exam (P < .001). CONCLUSION After an introduction to the HEADS examination, most students covered almost all of the topic areas of this screening interview during a SPE. Only three-fifths of the students, however, included questions about symptoms of depression. Coached role play with goal-setting facilitated effective learning of this approach to adolescent interviewing.
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Affiliation(s)
- Paritosh Kaul
- Section of Adolescent Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Jennifer H Fisher
- University of Colorado Anschutz Medical Campus, College of Nursing, Aurora, Colorado
| | - Janice L Hanson
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Parasuraman SR, Johnson SL, Magnusson D, King T. Meeting Quality Measures for Adolescent Preventive Care: Assessing the Perspectives of Key Stakeholders. Jt Comm J Qual Patient Saf 2018; 44:146-154. [PMID: 29499811 DOI: 10.1016/j.jcjq.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/26/2017] [Accepted: 07/17/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Health plans are increasingly implementing quality improvement strategies aimed at meeting adolescent clinical quality measures, yet clinics often struggle to meet these measures. This qualitative study was conducted to explore how efforts to meet the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS) performance measure for adolescent well-care visits were perceived by a multidisciplinary group of stakeholders. METHODS The research team conducted 26 in-depth, semistructured interviews with participants from three stakeholder groups: clinic staff with direct patient contact, health care institutional leaders, and representatives of a payer organization. Interviews were about 45 minutes in duration, audio-recorded, and professionally transcribed. Framework analysis was used to identify and organize emergent themes, and Atlas.ti was used to facilitate data management and analysis. RESULTS Stakeholder groups diverged in their opinions regarding strategies for achieving adolescent quality measures. Stakeholders with no direct patient interaction touted transactional quality improvement strategies that directly incentivized patients and families. In contrast, clinic staff with direct patient contact believed that incentive-based efforts undermined patient-provider relationships and the clinics' focus on wellness. CONCLUSION A considerable disconnect exists between stakeholders with and without patient contact with regard to approaches to the delivery of well care and quality improvement strategies for meeting the adolescent well-care visit performance measure. Efforts to reconcile discordant perspectives and promote a mutual understanding between payers, institutional leaders, and clinic staff could inform the development of creative initiatives that are sustainable and effective at achieving adolescent and family engagement, as well as clinical performance benchmarks.
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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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Wood D, Geoghegan S, Ramnarayan P, Davis PJ, Pappachan JV, Goodwin S, Wray J. Eliciting the experiences of the adolescent-parent dyad following critical care admission: a pilot study. Eur J Pediatr 2018; 177:747-752. [PMID: 29468417 PMCID: PMC5899104 DOI: 10.1007/s00431-018-3117-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/31/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
UNLABELLED Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay. Participants were 14-17 year olds who had previously had an emergency admission to an adult or paediatric ICU/HDU in one of four UK hospitals (two adult, two paediatric) and their parents. Semi-structured interviews were conducted with eight mother-adolescent dyads and one mother. Interviews were transcribed and analysed using framework analysis. CONCLUSION The main reported determinant of high-quality care was the quality of interaction with staff. The significance of these interactions and their environment depended on adolescents' awareness of their surroundings, which was often limited in ICU and changed significantly over the course of their illness. Qualitative interview methodology would be difficult to scale up for this group. What is known • Critically ill adolescents are usually treated on intensive care units optimised for older adults or younger children. • The way they access and experience health services may be different to most adolescent patients; existing quality criteria may not apply. What is new • Reported determinants of high-quality care were age-appropriateness of the environment, respectfulness and friendliness of staff, communication and inclusion in healthcare decisions. • The significance of these depended on adolescents' awareness of their surroundings, which was often limited and changed over the course of their illness.
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Affiliation(s)
- Dora Wood
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW, UK.
| | - Sophie Geoghegan
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability, Great Ormond Street Hospital, WC1N 3JH, London, UK
| | | | - Peter J. Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW UK
| | - John V. Pappachan
- Department of Paediatric Intensive Care, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - Sarah Goodwin
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, Bristol, BS2 8HW UK
| | - Jo Wray
- Critical Care and Cardiorespiratory Division, Great Ormond Street Hospital, WC1N 3JH, London, UK
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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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Reimagining Childhood: Responding to the Challenge Presented by Severe Developmental Disability. HEC Forum 2017; 29:241-256. [DOI: 10.1007/s10730-017-9331-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Minor-aged patients are often brought to the pediatrician for nonurgent acute medical care, physical examinations, or health supervision visits by someone other than their legally authorized representative, which, in most situations, is a parent. These surrogates or proxies can be members of the child's extended family, such as a grandparent, adult sibling, or aunt/uncle; a noncustodial parent or stepparent in cases of divorce and remarriage; an adult who lives in the home but is not biologically or legally related to the child; or even a child care provider (eg, au pair, nanny, private-duty nurse/nurse's aide, group home supervisor). This report identifies common situations in which pediatricians may encounter "consent by proxy" for nonurgent medical care for minors, including physical examinations, and explains the potential for liability exposure associated with these circumstances. The report suggests practical steps that balance the need to minimize the physician's liability exposure with the patient's access to health care. Key issues to be considered when creating or updating office policies for obtaining and documenting consent by proxy are offered.
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