Access by the unaccompanied under-16-year-old adolescent to general practice without parental consent

Confidentiality and parental involvement in adolescent sexual and reproductive health care: A cross-sectional study of Lithuanian general practitioners

Aim: We surveyed Lithuanian general practitioners’ (GPs) views on the importance of confidentiality for adolescents and on their practices in informing parents about sexual and reproductive health consultations with this age group. Methods: In this cross-sectional study, a 41-item questionnaire was sent to a random sample of 607 Lithuanian GPs. The purpose of this questionnaire was to gain knowledge about current practices of GPs in informing parents on the importance of confidentiality as well as in protecting the privacy of minors. GPs’ knowledge of the current legal age limit of confidentiality protection in patient-provider settings was also assessed. Results: Although 67.5% of the responding GPs (response rate 73.5%) stated that they inform the parents or guardians of adolescent patients about the importance of confidentiality, 82.9% of them only did so if the opportunity arose. When consulting on general sexual issues, more than 70% stated that they would guarantee their minor patients confidentiality. However, when cases involved sexually transmitted infections or pregnancy, nearly the same percentage said they would inform the parents. 62.3% of GPs incorrectly believed that the law only protects the right to confidentiality for patients who are 18 or older. Conclusions: Our findings indicate that Lithuanian GPs frequently violate adolescents’ right to confidential health services. The study highlights the need for a comprehensive strategy to strengthen the confidentiality of sexual and reproductive health services for this group in Lithuanian primary care.

Adolescents consulting a GP accompanied by a third party: comparative analysis of representations and how they evolve through consultation

BACKGROUND

Adolescents are frequently accompanied by a third party in consultation. Their stated reason for consulting is rarely psychological. However, many adolescents experience distress or impaired well-being that practitioners fail to detect.

OBJECTIVES

To study the ability of adolescents to express personal concerns in general medicine consultations depending on if an accompanier is present and to explore perceptions of participants and how they evolved.

METHODS

Six hundred and seventy-four adolescent consultations with 53 GPs were studied. The adolescents and any persons accompanying completed self-administered questionnaires before and after the consultation, the GPs only afterwards. Analyses compared responses before and after consultation and between participants.

RESULTS

Six per cent of the adolescents were consulting for a psychological reason, but, among the others, 17% reported having personal concerns they would like to talk about. Among adolescents aged 14-17 years, those consulting alone more frequently reported personal worries but were more satisfied with the consultation than the others. A third party's presence did not appear to hinder expression for those that consulted accompanied. The representations of the third party and practitioner concerning the adolescent differed, although they tended to converge following the consultation: accompaniers overestimated the adolescents' well-being and freedom to talk, while GPs underestimated their well-being, readiness to confide and feelings of being understood.

CONCLUSIONS

GPs could be more optimistic about adolescent consultations: their role is viewed more positively than they think, especially by adolescents consulting alone. The majority of adolescents wishing to say something do so, even when an accompanier is present.