Challenges of Providing Confidential Care to Adolescents in Urban Primary Care: Clinician Perspectives

Abstract

PURPOSE Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confi dential services. METHODSWe undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine. RESULTSThe annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal confl ict about providing confi dential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confi dential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen.CONCLUSION Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Offi ce systems should be developed that enhance the consistency of delivery of confi dential services.

Health Care Experiences and Needs of Adolescents in Urban Greece: Implications for Planning Appropriate Health Care

“…Furthermore, studies have reported that a familiar trusted person can improve communication and adolescents are more willing to discuss topics that have been previously discussed [31]. Time available for consultation is an important parameter of increased quality in health care of adolescents, as has been consistently shown [23,24,27,32,33]. Confidentiality and privacy have been also shown to be critical for high quality health care for adolescents and research has shown that adolescents who forgo health care due to confidentiality concerns are particularly vulnerable and in need of health services [34,35].…”

“…The issue of adolescent confidentiality in health care presents challenges for health care providers related to family, medical, ethical, legal, social and administrative processes [36]. Parents are usually willing to allow their daughters and sons consult doctors alone, as long as confidentiality policy and limitations are explained to them [33]. The importance of parents' agreeing to a private discussion is related to the legal aspects of consent, competence and confidentiality regarding adolescents under the age of 18 in the context of the legal framework of any given country [18,35,37].…”

“…Even though parental consent may be granted, uncertainty over ethical and legal rights and responsibilities may lead professionals to refuse to see adolescents on their own for fear of incurring parental wrath or even legal action [37,38]. Due to the importance of these issues, various health care organizations have issued relevant guidelines [33]. Of note, none of the specialties involved in primary care of adolescents in Greece have any systematic training in adolescent medicine, while this is not a recognized subspecialty in Greece.…”

Standards for Health Information Technology to Ensure Adolescent Privacy

“…13 Privacy and trust between the adolescent and provider during the health care visit is complicated by requirements to document care in the record, bill for services, and communicate with the parent/guardian within the boundaries of applicable state laws. [14][15][16] PHRs can improve access to health information, but to realize the benefits for teenagers, standards for developing and accessing the information within PHRs must include the ability to protect privacy and security issues for adolescents. The PHR must have the flexibility to meet the variation in the legal mandates of the state in which the teenager resides.…”

The HPV Vaccine and Parental Consent

“…"Time alone" has been shown to significantly increase the likelihood that adolescents will discuss sensitive health matters and is generally supported by parents and appreciated by patients [1][2][3].…”